Capital Magnet Fund Environmental Review Form

DEPARTMENT OF THE TREASURY

WASHINGTON, D.C. 20220

COMMUNITY DEVELOPMENT FINANCIAL INSTITUTIONS FUND

Capital Magnet Fund Environmental Review Form

Applicant/Recipient Name: ______________________________

Award Control Number: _________________________

Project Address: _______________________________

The CDFI Fund’s environmental review requirements are set forth in 12 CFR Part 1815. The Applicant/Recipient should review such regulations carefully before completing this section. In order to assure compliance with those regulations and other related requirements, the Applicant/Recipient shall answer the following questions for every project prior to the Project Commitment of CMF Award dollars.

NOTE: If the answer to any of these items is “Yes,” the Applicant/Recipient must submit the completed form to the CDFI Fund no later than 90 days (CMF Award years 2019 and prior) or 180 days (CMF Award years 2020 and subsequent) prior to Project Commitment, as specified in the Recipient’s Assistance Agreement. If the answer to all questions below is “No,” then the Applicant/Recipient should not submit the form to the CDFI Fund.

ITEMS	YES	NO
Are there any actions proposed by the Applicant/Recipient that do not constitute a “categorical exclusion” as defined in 12 CFR 1815.110?
If YES, would any of these actions normally require an environmental impact statement (see 12 CFR 1815.108)?
Are there any activities proposed by the Applicant/Recipient that involve:
Historical or archaeological sites listed on the National Register of Historic Places, or that may be eligible for such listing?
Wilderness areas designated or proposed under the Wilderness Act?
Wild or scenic rivers proposed or listed under the Wild and Scenic Rivers Act?
Critical habitats of endangered or threatened species?
Natural landmarks listed on the National Registry of Natural Landmarks?
Coastal barrier resource systems?
Coastal Zone Management Areas?
Sole Source Aquifer Recharge Areas designated by EPA?
Wetlands?
Flood plains?
Prime and unique farmland?
Properties listed or under consideration for listing on the Environmental Protection Agency’s List of Violating Facilities?

If the answer to any of the above questions is “Yes,” then attach a detailed description of each action, clearly identifying the category in which the action falls.

Notification

If the CDFI Fund determines that the Applicant/Recipient’s proposed project requires an environmental assessment or an environmental impact statement, any approval for the Recipient to Commit CMF Award dollars to a project will be contingent upon:

1. The Applicant/Recipient supplying to the CDFI Fund all information necessary to support that the project is already undergoing (or has undergone) an environmental review as a condition of other funding (e.g. state or federal funding) and the outcome of the environmental review; or

2. The Applicant/Recipient submitting to the CDFI Fund all information necessary for the CDFI Fund to perform any required environmental review and the outcome of the environmental review.

Paperwork Burden Statement

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid Office of Management and Budget (OMB) Approval Number. This form's Approval Number is 1559-NEW. Public reporting burden for this collection of information is estimated to average 0.50 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Community Development Financial Institutions Fund, 1500 Pennsylvania Ave, NW, Washington, DC 20220.

OMB Approval No. 1559-NEW

Catalog of Federal Domestic Assistance Number: 21.011