Online application screen shots

TVA 26a - Shoreline Construction Online Permit Application - Applicant/Agent Information

Page 1 of 2

Section 26a of the TVA Act

Shoreline Construction Online Permit Application
The Department of the Army (DA) permit program is authorized by Section 10 of the Rivers and
Harbors Act of 1899 and Section 404 of the Clean Water Act (P.L. 95-217). These laws require
permits authorizing structures and work in or affecting navigable waters of the United States and the
discharge of dredged or fill material into waters of the United States. Section 26a of the Tennessee
Valley Authority Act, as amended, prohibits the construction, operation, or maintenance of any
structure affecting navigation, flood control, or public lands or reservations across, along, or in the
Tennessee River or any of its tributaries until plans for such construction, operation, and maintenance
have been submitted to and approved by the Tennessee Valley Authority (TVA).
* = Required field

Applicant Information
First

Last

* Applicant Name:
Company Name:
* Address:
Address 2:
* City:
* State:

-- Please Choose --

* Zip Code:

(5 or 9 digits, no spaces or special characters)

* Primary Phone:
Secondary Phone:

(include area code, no spaces or special characters)
(include area code, no spaces or special characters)

* Email:

Authorized Agent Information

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 1.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Applicant/Agent Information

First

Page 2 of 2

Last

Agent Name:
Title:
Company Name:
Address:
Address 2:
City:
State:

-- Please Choose --

Zip Code:
Primary Phone:
Secondary Phone:

(5 or 9 digits, no spaces or special characters)
(include area code, no spaces or special characters)
(include area code, no spaces or special characters)

Email:

Next: Disclosure Form

Cancel

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 1.htm

06/07/2010

TVA Section 26a Permit and Land Use Application - Applicant Disclosure Form

Page 1 of 2

Section 26a Permit Application
Applicant Disclosure Form
By signing the Joint Application Form (Department of Army/TVA) or submitting electronically, you agree to disclose any business, political, or financial
interest that may present an actual or potential conflict of interest with TVA. If a new significant business, political, or financial interest is obtained during
the period of the time that the application is under review, you agree to file an additional disclosure.
Disclose if any of the following apply to you (check all that apply). I am:
An elected government official
A policy making level employee of an entity that regulates TVA or its activities
A management level employee of a power customer of TVA
A TVA Director
A TVA employee
An immediate family member of one of the above
A representative of a corporation or entity submitting an application and one of the above applies to me. Print entity or corporation name, and
identify which of the above applies to you.
A representative of a corporation or entity submitting an application and the corporation or entity has partners, investors, or senior management
that are one of the above. Print entity or corporation name, and identify the partner(s), investor(s), or senior manager(s) and which of the above
applies.

None of the above
Do you have any other business or personal relationships not covered in your answers above that could appear to be a conflict of interest? Yes
No
If yes, provide more detail here.

By checking this box, you consent to this Applicant Disclosure Form being made available to the public in response to an appropriate request,
including, without limitation, a request made under the Freedom of Information Act.

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 2.htm

06/07/2010

TVA Section 26a Permit and Land Use Application - Applicant Disclosure Form

Page 2 of 2

Your application cannot be processed without this information.
Name of applicant (Printed): sample sample
All applications and communications that occur as part of the application process may be made public to the extent permitted by applicable law, including
the Freedom of Information Act and the Privacy Act, and could be reviewed formally by the Office of Inspector General (OIG). All written correspondence
regarding your request may be forwarded to the TVA Chief Ethics and Compliance Officer (CECO) and the OIG, and all oral communication between TVA
and the applicant regarding this request may be documented and maintained by TVA. Inquiries concerning your application from any person who falls into
one of the categories described above will be disclosed to the CECO and OIG.

Next: Activity Information

Privacy Act Statement
This information is being requested in accordance with Section 26a of the TVA Act. Disclosure of the information
requested is voluntary; however, failure to provide any required information or documents may result in a delay in
processing your application or in your application being denied. An application that is not complete will be returned for
additional information. TVA uses this information to assess the impact of the proposed project on TVA programs and the
environment and to determine if the project can be approved. Information in the application is made a matter of public
record through issuance of a public notice if warranted. Routine uses of this information include providing to federal,
state, or local agencies, and to consultants, contractors, etc., for use in program evaluations, studies, or other matters
involving support services to the program; to respond to a congressional inquiry concerning the application or the
applicable program; and for oversight or similar purposes, corrective action, litigation, or law enforcement.

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 2.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Activity Information

Page 1 of 3

Section 26a of the TVA Act

Shoreline Construction Online Permit Application
* = Required field

Activity Information
* Reservoir:

-- Please Choose --

* Address where activity will take place.
If same as Applicant Address, Check here:
Otherwise enter here:
Subdivision:

Lot Num:

Include stream name and mile, if known:

* Date activity is proposed to commence:

(mm/dd/yyyy)

* Date activity is proposed to be completed:

(mm/dd/yyyy)

Is any portion of the activity for which authorization is sought now complete?
* Yes

No

If Yes, date the activity was completed:

(mm/dd/yyyy)

If there is an existing permit, Permit Number:
Previous Owner:
* Activity Type: -- Please Choose --

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 3.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Activity Information

Page 2 of 3

* Proposed Activity Description
Describe in detail the proposed activity, its purpose and intended use (private, public, commercial
or other). Describe structures to be erected including those placed on fills, piles, or floating
platforms. Also describe the type, composition, and quantity of materials to be discharged or
placed in the water; the means of conveyance; and the source of discharge or fill material.

Adjoining Property Description
Names, addresses, and telephone numbers of adjoining property owners, lessees, etc., whose
properties also join the waterway.

Previous Permits
List previous DA/TVA permits or approvals (include permit numbers and dates).

Approval Certifications
List all approvals or certificates required by other federal, interstate, state, or local agencies for any
structures, construction, discharges, deposits, or other activities described in this application.
Include issuing agency, type of approval, identification number, and dates of application and
approval.

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 3.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Activity Information

Page 3 of 3

Approvals Denied
Has any agency denied approval for the activity described herein or for any activity directly related
to the activity described herein?
* Yes

No

If Yes, please explain:

Next: Upload Drawing(s)

Cancel

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 3.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Upload Drawing(s)

Page 1 of 1

Section 26a of the TVA Act

Shoreline Construction Online Permit Application
* = Required field

Upload Drawing(s)
Up to three drawings, photos or maps may be uploaded. File formats accepted are jpg, jpeg, pdf,
dxf, tif or tiff. Total file size limited to 8 mb.
* Upload File 1:

Browse...

Upload File 2:

Browse...

Upload File 3:

Browse...

Next: Payment Information

Cancel

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 4.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Payment Information

Page 1 of 3

Section 26a of the TVA Act

Shoreline Construction Online Permit Application
* = Required field

Payment Information
Name and address same as applicant?
* Name on Credit Card:
* Billing Address:
* City:
* State:

-- Please Choose --

* Zip Code:
* Card Type:

(5 or 9 digits, no spaces or special characters)

-- Please Choose --

* Card Number:

(no spaces or special characters)

* Security Code:
* Expiration Date:

(no spaces or special characters)

01

/ 2010

Application is hereby made for approval of the activities described herein. I certify that I am familiar with
the information contained in this application, and that to the best of my knowledge and belief such
information is true, complete, and accurate. I further certify that I possess the authority to undertake the
proposed activities. I agree that, if this application is approved by TVA, I will comply with the
attached terms and conditions and any special conditions that may be imposed by TVA at the
time of approval. Please note the U.S. Army Corps of Engineers may impose additional
conditions or restrictions.

I agree:

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 5.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Payment Information

Page 2 of 3

18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department
or agency of The United States knowingly and willfully falsifies, conceals, or covers up by any trick,
scheme, or device a material fact or makes any false, fictitious or fraudulent statements or
representations or makes or uses any false writing or document knowing same to contain any false,
fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more
than five years, or both. The appropriate DA fee will be assessed when a permit is issued.

By clicking the "Process Application" button, you authorize TVA and the Department of the Army
to process your application. In addition, by clicking the “Process Application” button, you
authorize TVA to charge the application fee of $200 to your credit card.

Process Application

Cancel

Privacy Act Statement
This information is being requested in accordance with Section 26a of the TVA Act. Disclosure of the
information requested is voluntary; however, failure to provide any required information or documents
may result in a delay in processing your application or in your being denied a Section 26a permit. An
application that is not complete will be returned for additional information. TVA uses this information to
assess the impact of the proposed project on TVA programs and the environment and to determine if the
project can be approved. Information in the application is made a matter of public record through
issuance of a public notice if warranted. Routine uses of this information include providing to federal,
state, or local agencies, and to consultants, contractors, etc., for use in program evaluations, studies, or
other matters involving support services to the program; to respond to a congressional inquiry
concerning the application or Section 26a program; and for oversight or similar purposes, corrective
action, litigation or law enforcement.

Burden Estimate Statement
Public reporting burden for this collection of information is estimated to average 1.5 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. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 5.htm

06/07/2010

TVA 26a - Shoreline Construction Online Permit Application - Payment Information

Page 3 of 3

reducing this burden to Agency Clearance Officer, Tennessee Valley Authority, 1101 Market Street,
Chattanooga, Tennessee 37402; and to the Office of Management and Budget, Paperwork Reduction
Project (3316-0060), Washington, D.C. 20503.

file://C:\Documents and Settings\kerylant\My Documents\Assignments\OMB Renewal 2010\Online Screen Shots\Online Application Screen 5.htm

06/07/2010