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<br />NEIL F 451.1-1/3
<br />(11/2007) OPI=320
<br />(Previous Editions obsolete) U.S. DEPARTMENT OF ENERGY
<br />ENVIRONMENTAL QUESTIONNAIRE
<br />BACKGROUND
<br />The Department of Energy (DOE) National Environmental Policy Act (NEPA) Implementing Procedures (10 CFR 1021)
<br />require careful consideration of the potential environmental consequences of all proposed actions during the early planning
<br />stages of a project or activity. DOE policy directs at the earliest possible stage in a project whether such actions will require
<br />preparation of an Environmental Assessment, an Environmental Impact Statement, or a Categorical Exclusion. To comply
<br />with these requirements, an Environmental Questionnaire (NETL Form 451.1-1/3) must be completed for each proposed
<br />action to provide DOE with the information necessary to determine the appropriate level of NEPA review and
<br />documentation. If the proposed project qualifies for Categorical Exclusion designation, a Categorical Exclusion Designation
<br />Form (NEIL Form 451.1-1/1) will also be completed in addition to the Environmental Questionnaire.
<br />II. INSTRUCTIONS
<br />Separate copies of the Environmental Questionnaire and Categorical Exclusion Designation Form (if required) should be
<br />completed by the principal proposer and principal subcontractor(s). In addition, if the proposed project includes activities at
<br />different locations, an independent questionnaire should be prepared for each location. Supporting information can be
<br />provided as attachments.
<br />In completing this Questionnaire, the proposer is requested to provide specific information and quantities, when applicable,
<br />regarding air emissions, wastewater discharges, solid wastes, etc., to facilitate the necessary review. The proposer should
<br />identify the location of the project and specifically describe the activities that would occur at that location. In addition, the
<br />proposer will be required to submit an official copy of the project's statement of work (SOW) or statement of project
<br />objective (SOPO) that will be used in the contract/agreement between the proposer and DOE.
<br />III. QUESTIONNAIRE
<br />A. PROJECT SUMMARY
<br />1. Solicitation/Project Number:
<br />2. Proposer and Subcontractor(s):
<br />3. Principallnvestigator:
<br />Telephone Number:
<br />4. Project Title:
<br />5. Duration:
<br />6. Location(s) of Performance (Ciry/Township, County, State):
<br />7. Identify and select the checkbox with the predominant project work activities under Group A-7a, A-7b, or A-7c.
<br />Group A-7a
<br />Categorical Exclusion CX-A: Routine administrative, procurement, training, and personnel actions. Contract
<br />activities/awardsfnr management support, fmancial assistance, and technical services in support of agency business,
<br />programs, projects, and goals. Literature searches and information gathering, material inventories, property surveys;
<br />data analysis, computer modeling, analytical reviews, technical summary, conceptual design, feasibility studies,
<br />document preparation, data dissemination, and paper studies. Technical assistance including financial planning,
<br />assistance, classroom training, public meetings, management training, survey participation, academic contribution,
<br />technical consultation, and stakeholders surveys. Workshop and conference planning, preparation, and
<br />implementation which may involve promoting energy efficiency, renewable energy, and energy conservation.
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