Fillable NHPA / NEPA Questionnaire (National Endowment for the Arts)

Fill Online, Printable, Fillable, Blank NHPA / NEPA Questionnaire (National Endowment for the Arts) Form

Use Fill to complete blank online NATIONAL ENDOWMENT FOR THE ARTS (DC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

NHPA / NEPA Questionnaire (National Endowment for the Arts)

On average this form takes 8 minutes to complete

The NHPA / NEPA Questionnaire (National Endowment for the Arts) form is 7 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 33 other fields

Country of origin: US
File type: PDF

U.S.A. forms for National Endowment for the Arts

BROWSE NATIONAL ENDOWMENT FOR THE ARTS (DC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
OMB No. 3135-0112
Expires 11/30/19
OMB No. 3135-0112
Expires 12/31/19
NHPA / NEPA Questionnaire
8/4/16
I
f you are recommended for a grant, your project may be subject to the National Environmental Policy Act
(NEPA)
and/or the National Historic Preservation Act (NHPA). The NEA will conduct a review of your project to ensure that it is
in compliance with NEPA/NHPA.
S
ome of the common project types that garner a NHPA review are:
• A project involving or occurring near a district, site, building, landscape, structure or object that is 50 years old
and therefore eligible for inclusion in the National Register of Historic Places.
• The commissioning and installation of temporary or permanent outdoor furnishings such as benches or market
structures or art such as a sculpture or mural.
• A
n arts festival in a park.
• Design planning and services for projects that may involve a historic site, structure, or district.
Th
is is the first step in the NHPA review process. Based in your responses, the NEA will determine one of the following
outcomes:
1. There are no anticipated adverse effects on historic properties or resources;
2. Based on an agreement that the NEA has with the Advisory Council on Historic Preservation
(ACHP), one or
more approved exemptions can be applied to the project, confirming that there are no anticipated adverse
effects on historic properties or resources; or
3. The project has the potential to have adverse effects on historic properties or resources. You are asked to
contact and work directly with your State Historic Preservation Office
(SHPO), and potentially initiate a Section
106 Review.
INSTRUCTIONS
Applicants:
Fill out the following form for every project location. Return it along with the Project Budget to the Specialist indicated
on the tentative funding notification.
If you have revised your project as a result of the tentative funding notification, clearly indicate such on the Project
Budget form under "Project Description." Specifically indicate if the revised project no longer involves activities that
require NEPA/NHPA review. For example, because of the reduced funding amount a three-pronged project that
included an outdoor mural was reduced to a two-pronged project without the mural.
Current Award Recipients:
Fill out the following form for every project location. Submit it to the Grants & Contracts Office at grants@arts.gov. If
you are revising the budget too, indicate if the revised project no longer involves activities or locations that require
NEPA/NHPA review.
For All:
Include maps and photographs of each location and property. Be as concise as possible.
If you have questions regarding NHPA / NEPA or the process please contact neahistoricreview@arts.gov
.
Organization:
Application/Award #:
Page 2 of 7
GENERAL INFORMATION
A. Organization Name. Enter the legal name of your organization.
B. NEA Application/Award Number. Enter the application or award number. C. Date
D. Contact Information. Identify the person who can answer specific questions about NEPA or NHPA.
Name
Title
Email
Phone Number
ANSWER THE FOLLOWING NHPA / NEPA QUESTIONS
1. Provide a very clear description of the district, building, site, landscape, structure, or object in which you will be
working, including the address(es). If you don’t have a physical address, provide the block or other area of potential
effect. Describe the nature of your site, whether activities will take place in public space, streets, vacant lots, historic
structures, etc. Include a map.
Organization:
Application/Award #:
Page 3 of 7
2. Describe your project activities, including whether the planned activities are temporary or permanent. Provide a
short assessment of whether your project has the potential to have an effect on environmental or historic resources
and whether that effect is an adverse effect.
If your project will physically alter a district, site, building, landscape, structure or object, or if you are working on a
plan or design for such a site, describe. For example, if you are commissioning permanent public art, murals, or the
design of a permanent structure, your project has the potential to have an adverse effect on environmental or
historic resources under NEPA/NHPA.
3. For the purposes of questions (a)-(i) below, a National Historic Register Place (NHRP) includes any district, site,
building, structure, landscape or object that is included or eligible for inclusion on the NHRP, whether individually or
as a contributing element. Generally, NHRP Sites will include
(1) any place 50 years old or older,
(2) any place included or eligible for inclusion in the NHRP, or
(3) located in a historic district.
Additionally, understand that for a project to be temporary it must be 100% reversible.
a. Does your project involve a festival/public event of limited size or duration? If so, will there be any permanent
effects on a NHRP Site(s) or any structures/installations erected or installed on an NHRP Site(s)?
Organization:
Application/Award #:
Page 4 of 7
b. Does your project involve outdoor murals or other art on a NHRP Site(s) or adjacent to a NHRP Site(s)?
c. Does your project involve temporary public art on a building 50 years or older (e.g., sculpture, statuary, banners,
mixed media, painting)? If so, does the project necessitate the installation of hardware on a NHRP Site(s)?
d. Does your project involve erecting or placing permanent wayfinding signs (e.g., artistic directional signs) adjacent
to or on a NHRP Site(s)?
e. Does your project involve installing small structures (e.g., benches, bus shelters, produce stands) attached to or
dependent on a NHRP Site(s)? If so, describe the ground disturbance necessary for such an installation.
Organization:
Application/Award #:
Page 5 of 7
f. Does your project involve landscape maintenance or rehabilitation (e.g., community garden, urban park) on a
NHRP Site(s)? If so, where? Will it include the addition of new large scale landscape elements?
g. Does your project involve in-kind replacements or repairs?
h. Does your project involve conceptual planning/design/research (e.g., feasibility and planning studies, early design
development work/conceptual drawings and renderings, asset mapping, design charrettes)?
i. Does your project involve information gathering/data analysis/information dissemination (e.g., historic and
cultural demonstrations, public affairs actions, studies, reports, document mailings, data analysis)?
Organization:
Application/Award #:
Page 6 of 7
4. If you are proposing a temporary or permanent public art project, or you are designing or planning a district,
building, site, landscape, structure or object, you must provide us with the following detailed information:
If any element of the district, building, site, landscape, structure or object (or adjacent properties) is 50 years old or
older, describe that element in detail. For example, if you are working on a historic building or district (or there is
one adjacent), describe the age (give year built if available), whether or not it's included in or eligible for inclusion in
the National Register of Historic Places, and the type of activities being planned or designed for your project.
5. Provide a detailed description of any project activities that might now or someday have an effect on the
environment so that we may review the actions under the NEPA. Be very specific. For example, if you will be doing
cleanup of a site, describe exactly what needs to be cleaned. Is it litter on the site or toxic waste that needs to be
cleaned up? If you will be installing public art, describe the previous use of the property and why you think the land
is not likely to be contaminated.
Organization:
Application/Award #:
Page 7 of 7
6. If an Indian tribe or Native Hawaiian organization might attach religious and/or cultural significance to historic
properties touched by your project, describe.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

NHPA NEPA Questionnaire (National Endowment for the Arts)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 7 October 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document