RD1940-20.pdf

32. Coastal Barrier Resources System

USDA Position 3 FORM APPROVED OMB No. 0575-0094Form RD 1940-20

REQUEST FOR ENVIRONMENTAL INFORMATION

(Rev. 4-06) Name of Project

Location

Item 1a. Has a Federal, State, or Local Environmental Impact Statement or Analysis been prepared for this project?

Yes No Copy attached as EXHIBIT I-A.

1b. If ''No.'' provide the information requested in Instructions as EXHIBIT I.

Item 2. The State Historic Preservation Officer (SHPO) has been provided a detailed project description and has been requested to submit

Yes comments to the appropriate Rural Development Office. No Date description submitted to SHPO Item 3. Are any of the following land uses or environmental resources either to be affected by the proposal or located within or adjacent to the project site(s)? (Check appropriate box for every item of the following checklist).

Yes No Yes

(designated or proposed under the Wilderness Act)

(proposed or designated under the Wild and Scenic Rivers Act)

(Listed on the National Register of Historic Places or which may be eligible for listing)

(endangered/threatened species)

(Listed on National Registry of Natural Landmarks)

Item 4. Are any facilities under your ownership, lease, or supervision to be utilized in the accomplishment of this project, either listed or under Yes Noconsideration for listing on the Environmental Protection Agency's List of Violating Facilities?

Signed:

(Date) (Applicant)

(Title)

Unknown No Unknown

6. Mining, Quarrying

5. Grazing

4. Agricultural

3. Residential

1. Industrial

2. Commercial

19. Dunes

20. Estuary

21. Wetlands

22. Floodplain

23. Wilderness

24. Wild or Scenic River

7. Forests

8. Recreational

9. Transportation

10. Parks

11. Hospital

12. Schools

13. Open spaces

14. Aquifer Recharge Area

15. Steep Slopes

16. Wildlife Refuge

17. Shoreline

18. Beaches

25. Historical, Archeological Sites

26. Critical Habitats

27. Wildlife

28. Air Quality

29. Solid Waste Management

30. Energy Supplies

31. Natural Landmark

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collections is 0575-0094. The time required to complete this information collection is estimated to average 6 to 10 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.