PROJECTPROGRAM NAME PROJECTPROGRAM ID NUMBER PROJECT LOCATION (IF APPLICABLE)

AMENDED IN NOVEMBER 2013 REQUEST FOR PROJECTPROGRAMME FUNDING FROM
PROJECTPROGRAM NAME PROJECTPROGRAM ID NUMBER PROJECT LOCATION (IF APPLICABLE)
REFERENCE RECORD TYPE1 ABSCHCB ABS CAPACITYBUILDING INITIATIVE (ACTIVITYPROJECTPROGRAMME) MANDATORY

REGIONAL PROJECTPROGRAMME PROPOSAL ROUNDED RECTANGLE 5 PART I PROJECTPROGRAMME

CHAPTER XXX: XXXXXX



Project/Program Name:





Project/Program ID Number:

Project Location (if applicable):



Level of Environmental Review Completed:

Date Commitment and Expenditure of Funds was authorized by the Responsible Entity/Environmental Certifying Officer: _________________________

PROJECTPROGRAM NAME PROJECTPROGRAM ID NUMBER PROJECT LOCATION (IF APPLICABLE)

Exempt [§58.34(a)] Date completed: _____________________________

Environmental Review Status Form submitted to KY DLG Date: _____________

Exempt/CENST determination form

Request for Approval of Evidentiary Materials and Release of Funds submitted to
KY DLG with copy of the above completed form Date: ___________________

PROJECTPROGRAM NAME PROJECTPROGRAM ID NUMBER PROJECT LOCATION (IF APPLICABLE)

Categorically excluded not subject to §58.5 [§58.35(b)]
Date completed: _________________________

Environmental Review Status Form submitted to KY DLG Date: _____________

Exempt/CENST determination form

Request for Approval of Evidentiary Materials and Release of Funds submitted to
KY DLG with copy of the above completed form Date: ___________________

PROJECTPROGRAM NAME PROJECTPROGRAM ID NUMBER PROJECT LOCATION (IF APPLICABLE)

Categorically excluded subject to §58.5 [§58.35(a)]:

Converted to exempt (§ 58.35(a)(12) Date converted: ______________

OR



NOI/RROF published Date: ______________

Environmental Certification submitted to KY DLG Date: _______________

Request for Approval of Evidentiary Materials and Release of Funds submitted
to KY DLG Date: ________________

Environmental Review Status Form-submitted to KY DLG

KY State eClearinghouse comments-submitted to KY DLG

KY Heritage Council-SHPO comments and approval- submitted to KY DLG

All required publication(s) tear sheets- submitted to KY DLG

KY DLG Approval received Date signed by KY DLG: ________________

PROJECTPROGRAM NAME PROJECTPROGRAM ID NUMBER PROJECT LOCATION (IF APPLICABLE)

Environmental Assessment (§58.36)

FONSI/NOI published Date: _________________

Environmental Certification submitted to KY DLG Date: ____________________

Request for Approval of Evidentiary Materials and Release of Funds submitted
to KY DLG Date: __________________________

Environmental Review Status Form submitted to KY DLG Date: _____________

KY State eClearinghouse comments submitted to KY DLG

KY Heritage Council-SHPO comments and approval- submitted to DLG

All required publication(s) tear sheets- submitted to KY DLG

KYDLG approval received Date signed by KY DLG: ______________________

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Tags: projectprogram, number, project, location, applicable)