EHP - Environmental Screening Form

OMB Control#: 1660-0115
Expiration Date: 1/31/2017

Grant Programs Directorate

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA)
ENVIRONMENTAL AND HISTORIC PRESERVATION SCREENING FORM
Paperwork Burden Disclosure Notice
Public reporting burden for this data collection is estimated to average 8 hours per response. The burden estimate includes the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form.
This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless a
valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for
reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500
C Street, Washington, DC, 20472, Paperwork Reduction Project (1660-0115).

Privacy Act Statement
AUTHORITY: The National Environmental Policy Act of 1969, as amended, Pub. L. No. 91-190, § 102, 42 U.S.C. §§ 4321-4347; and National
Historic Preservation Act of 1966, as amended, Pub. L. No. 89-665, § 102, 16 U.S.C. § 470.
PRINCIPAL PURPOSE(S): This information is being collected for the primary purpose of determining eligibility and administration of FEMA
Preparedness Grant Programs and to ensure compliance with existing laws and regulations regarding the environment and historic preservation.
ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as
amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA – 004 Grants Management
Information Files System of Records, 74 Fed. Reg. 39,705 (Aug. 7, 2009) and upon written request, by agreement, or as required by law.
DISCLOSURE: The disclosure of information on this form is required by law and failure to provide the information requested may delay or prevent
the organization from receiving grant funding.

Directions for completing this form: This form is designed to initiate and facilitate the environmental
and historic preservation (EHP) compliance review for your FEMA preparedness grant-funded project(s).
FEMA conducts its EHP compliance reviews in accordance with National Environmental Policy Act
(NEPA) and other EHP-related laws and executive orders. In order to initiate EHP review of your
project, you must complete all relevant sections of this form and submit it to the Grant Programs
Directorate (GPD) along with all other pertinent project information. Failure to provide requisite
information could result in delays in the release of grant funds. Be advised that completion of this form
does not complete the EHP review process. You will be notified by FEMA when your review is
complete and/or if FEMA needs additional information.
There is no need to complete and submit this form if the grant scope is limited to planning, management
and administration, classroom-based training, tabletop exercises and functional exercises, or purchase of
mobile and portable equipment where no installation is needed. Information Bulletin 345, Grant
FEMA Form: 024-0-1

OMB Control#: 1660-0115
Expiration Date: 1/31/2017

Programs Directorate Programmatic Environmental Assessment, September 1, 2010, provides details
on these activities.

FEMA Form: 024-0-1

OMB Control#: 1660-0115
Expiration Date: 1/31/2017

This form should be completed electronically. The document is available in both Word and Adobe
Acrobat (pdf) formats at this website:
(http://www.fema.gov/library/viewRecord.do?fromSearch=fromsearch&id=4802. The following website
has additional guidance and instructions on the EHP review process and the information required for the
EHP review: http://www.fema.gov/plan/ehp/ehpreview/index.shtm
Submit completed form through your grant administrator who will forward it to GPDEHPInfo@dhs.gov.
Please use the subject line: EHP Submission: Project Title, location, Grant Award Number (Example,
EHP Submission: Courthouse Camera Installation, Any Town, State, 12345; 2011-SS-0xxxx).

SECTION A. PROJECT INFORMATION
DHS Grant Award Number:......
Grant Program: ..........................
Grantee ........................................
Grantee POC: ......................
Mailing address: ..................
E-mail: ..................................
Sub grantee: ................................
Subgrantee POC: .................
Mailing address: ..................
E-mail: ..................................
Estimated cost of project: ..........

Project title:
Project location (physical address or latitude-longitude):
Project Description. Provide a complete project description. The project description should contain a summary
of what specific action is proposed, where it is proposed, how it will be implemented. Include a brief description of
the objectives the project is designed to accomplish (the purpose), and the reason the project is needed. Use
additional pages if necessary. If multiple sites are involved, provide the summary for each site:

FEMA Form: 024-0-1

SECTION B. PROJECT TYPE
Based on the proposed project activities, determine which project type applies below and complete the
corresponding sections that follow. For multi-component projects or those that may fit into multiple project types,
complete the sections that best apply and fully describe all major components in the project description. If the
project involves multiple sites, information for each site (such as age of structure, location, ground disturbance, etc.)
must be provided. Attach additional pages to this submission, if needed.
1.

Purchase of equipment. Projects in this category involve the purchase of equipment that will require
installation on or in a building or structure. Complete other portions of Section B as needed. Complete
Section C.1.

2.

Training and exercises. Projects in this category involve training exercises with any field-based
components, such as drills or full-scale exercises. Complete Section C.2.

3.

Renovations/upgrades/modifications or physical security enhancements to existing structures.
Projects in this category involve renovations, upgrades, retrofits, and installation of equipment or systems
in or on a building or structure. Examples include, but are not limited to: interior building renovations;
electrical system upgrades; sprinkler systems; vehicle exhaust systems; closed circuit television (CCTV)
cameras; security fencing; access control for an area, building, or room; bollards; motion detection systems;
alarm systems; security door installation or upgrades; lighting; and audio-visual equipment (projectors,
smart boards, whiteboards, monitors, displays, and projector screens). Complete Section C.3.

4.

Generator installation. Projects in this category involve installation of new or replacement generators, to
include the concrete pads, underground fuel and electric lines, and if necessary, a fuel storage tank.
Complete Section C.4.

5.

New construction/addition. Projects in this category involve new construction, addition to, or expansion
of a facility. These projects involve construction of a new building, or expansion of the footprint or profile
of a current structure. Complete Section C.5.

6.

Communication towers, antennas, and related equipment. Projects in this category involve
construction of new or replacement communications towers, or installation of communications-related
equipment on a tower or building or in a communications shelter or building. Complete Section C.6.

7.

Other. Projects that do not fit in any of the categories listed above. Complete Section C.7.

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-1

SECTION C. PROJECT TYPE DETAILS
Check the box that applies to the proposed project and complete the corresponding details.
1.

Purchase of equipment. If the entire project is limited to purchase of
mobile/portable equipment and there is no installation needed, this form
does not need to be completed and submitted.
a. Specify the equipment, and the quantity of each: .......................................
b. Provide the Authorized Equipment List (AEL) number(s) (if known): ......
c. Complete Section D.

2.

Training and exercises. If the training is classroom and discussion-based
only, and is not field-based, this form does not need to be completed and
submitted.
a.

Describe the scope of the proposed training or exercise (purpose,
materials, and type of a activities required): ...............................................

b.

Provide the location of the training (physical address or latitudelongitude): ...................................................................................................

c.

Would the training or exercise take place at an existing facility which has
established procedures for that particular proposed training or exercise,
and that conforms with existing land use designations? For further
information refer to Information Bulletin #345,
http://www.fema.gov/pdf/government/grant/bulletins/info345.pdf : .......................................

Yes

No

Yes

No

Yes

No

• If Yes, provide the name of the facility and the facility point of
contact (name, telephone number, and email address): .........................
• If No, provide a narrative description of the area where the training
or exercise would occur (e.g., exercise area within four points
defined by latitude/longitude coordinates):............................................
• Does the field-based training/exercise differ from previously
permitted training or exercises in any way, including, but not limited
to frequency, amount of facilities/land used, materials or equipment
used, number of participants, or type of activities? ............................................................
• If Yes, explain any differences between the proposed activity and
Those that were approved in the past, and the reason(s) for the change
in scope: ...................................................................................................
• If No, provide reference to previous exercise (e.g., FEMA grant
name, number, and date): .........................................................................
d.

Would any equipment or structures need to be installed to facilitate
training? ...................................................................................................................................
• If Yes, complete Section D

3.

Renovations/upgrades/modifications, or physical security
enhancements to existing structures. If so, Complete Section D.

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-2

4.

Generator installation.
a.

Provide capacity of the generator (kW): .......................................................

b.

Identify the fuel to be used for the generator (diesel/propane/natural gas): ..

c.

Identify where the fuel for the generator would be stored (e.g. stand-alone
tank, above or below ground, or incorporated in generator): ........................

d.

Complete Section D.

5.

New construction/addition.
a.

Provide detailed project description (site acreage, new facility square
footage/number of stories, utilities, parking, stormwater features, etc): .......

b.

Provide technical drawings or site plans of the proposed project: ...........................................

c.

Complete Section D.

6.

Attached

Communication towers, antennas, and related equipment.
a.

Provide the current net height (in feet above ground level) of the existing
tower or building (with current attached equipment): ..................................

b.

Provide the height (in feet above ground level) of the existing tower or
building after adding/replacing equipment: ..................................................

Complete items 6.c through 6.q below ONLY if this project involves construction of a new or replacement
communications tower. Otherwise continue to Section D.
Information Bulletin 351, National Historic Preservation Act Section 106 Review Requirements for
Communications Facilities, January 4, 2011 has additional guidance and information on EHP requirements for
communications towers. Available at: http://www.fema.gov/pdf/government/grant/bulletins/info351.pdf
c.

Provide the ground-level elevation (feet above mean sea level) of the site
of the proposed communications tower: .......................................................

d.

Provide the total height (in feet above ground level) of the proposed
communications tower or structure, including any antennas to be mounted:
• If greater than 199 feet above ground level, state why this is needed
to meet the requirements of the project:...................................................

e.

Would the tower be free-standing or require guy wires? .............................

Free standing

Guy wires

• If guy wires are required, state number of bands and the number of
wires per band:.........................................................................................
• Explain why a guyed tower is needed to meet the requirements of
this project: ..............................................................................................
f.

What kind of lighting would be installed, if any (e.g., white strobe, red
strobe, or steady burning)? ............................................................................

g.

Provide a general description of terrain (e.g., mountainous, rolling hills,
flat to undulating): .........................................................................................

h.

Describe the frequency and seasonality of fog/low cloud cover: ..................

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-3

i.

Provide a list of habitat types and land use at and adjacent to the tower
site (within ½ mile), by acreage and percentage of total (e.g., woodland
conifer forest, grassland, agriculture) water body, marsh: ............................

j.

Is there evidence of bird roosts or rookeries present within ½ mile of the
proposed site?...........................................................................................................................

Yes

No

Yes

No

Yes

No

• Describe how presence/absence of bird roosts or rookeries was
determined: ..............................................................................................
k.

Identify the distance to nearest wetland area (e.g., forested swamp,
marsh, riparian, marine) and coastline if applicable: ....................................

l.

Distance to nearest existing telecommunication tower: ................................

m. Have measures been incorporated for minimizing impacts to migratory
birds? ........................................................................................................................................
• If Yes, describe: .......................................................................................
n.

Has a Federal Communications Commission (FCC) registration been
obtained for this tower? ............................................................................................................
• If Yes, provide Registration #: ................................................................

• If No, why?................................................................................
o.

Has the FCC E106 process been completed? ...........................................................................

Yes

No

p.

Has the FCC Tower Construction Notification System (TCNS) process
been completed? .......................................................................................................................

Yes

No

Yes

No

• If Yes, attach the environmental documentation submitted as part of
the registration process including use of the Tower Construction
Notification System (TCNS), if applicable. FRN#: ................................
q.

Would any related equipment or structures need to be installed (e.g., backup
generator and fuel source, communications shelter, fencing, or security
measures)?................................................................................................................................
• If Yes, explain where and how each installation would be done. Provide
details about generator capacity (kW), fuel source, fuel location and
tank volume, amount of fencing, and size of communication shelter: .....

r.
7.

Complete Section D.
Other: Complete this section if the proposed project does not fit any of
the categories above.

a.

Provide a complete project description: ........................................................

b.

Complete Section D.

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-4

SECTION D. PROJECT DETAILS
Complete all of the information requested below.
1.

Project installation
a.

Explain how and where renovations/upgrades/modifications would take
place, or where equipment/systems will be installed: ...................................

b.

Would ground disturbance be required to complete the project or training? ...........................

Yes

No

Yes

No

Yes

No

Yes

No

• If Yes, provide total extent (depth, length, and width) of each grounddisturbing activity. Include both digging and trenching. For example,
light poles and fencing have unique ground-disturbing activities (e.g.,
six light poles, 24” dia. x 4’ deep; trenching 12” x 500’ x 18" deep;
22 fence posts, 12” diameter x 3’ deep, and 2 gate posts, 18” diameter
x 3’ deep): ................................................................................................

• If Yes, describe the current disturbed condition of the area (e.g.,
parking lot, road right-of-way, commercial development): .....................
c.

Would the equipment use the existing infrastructure for electrical
distribution systems? ...............................................................................................................
• If No, describe power source and detail its installation at the site: ..........

2.

Age of structure/building at project site
a.

Provide the year existing building(s) or structure(s) on/in/nearest to the
location involved in the proposed project was built: .....................................
• If the building or structure involved is over 45 years old and
significant renovation, rehabilitation, or modification has occurred,
provide the year(s) modified and briefly describe the nature of
the modification(s):..................................................................................

b.

Are there any structures or buildings that are 50 years old or older in or
adjacent to the project area? .....................................................................................................
• If yes, provide the location of the structure(s), ground-level color
photographs of the sructure(s), and identify their location(s) on an
aerial map: ...............................................................................................

c.

Is the project site listed in the National Register of Historic Places
(National Register), or in/near a designated local or National Register
Historic District? The internet address for the National Register
is: http://nrhp.focus.nps.gov .................................................................................................
• If Yes, identify the name of the historic property, site and/or district
and the National Register document number: ........................................

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-5

3.

Site photographs, maps and drawings
a.

b.

Attach site photographs. Site photographs are required for all projects.
Use the following as a checklist for photographs of your project. Attach
photographs to this document or as accompanying documents in your
submission.
• Labeled, color, ground-level photographs of the project site:.............................................

Required

• Labeled, color photograph of each location where equipment would be
attached to a building or structure:......................................................................................

Required

• Labeled, color aerial photograph of the project site:...........................................................

Required

• Labeled, color aerial photographs that show the extent of ground
disturbance (if applicable): .................................................................................................

Attached

• Labeled, color ground-level color photographs of the structure from
each exterior side of the building/structure (applicable only if
building/structure is more than 45 years old): ....................................................................

Attached

Are there technical drawings or site plans available? ............................................................

Yes

• If yes, attach: ......................................................................................................................

Attached

No

Appendix A has guidance on preparing photographs for EHP review
4.

Environmental documentation
a.

b.

c.

Is there any previously completed environmental documentation for this
project at this proposed project site (e.g., Environmental Assessment, or
wetland delineation, or cultural/archaeological study)? ...........................................................

Yes

• If Yes, attach documentation with this form: .....................................................................

Attached

Is there any previously completed agency coordination for this project
(e.g., correspondence with the U.S. Fish and Wildlife Service, State
Historic Preservation Office, Tribal Historic Preservation Office)? ........................................

Yes

• If Yes, attach documentation with this form: ......................................................................

Attached

Was a NEPA document was prepared for this project? ...........................................................

Yes

No

No

No

• If Yes, what was the decision? (Check one, and please attach):
Finding of No Significant Impact (FONSI) from an Environmental Assessment (EA) or
Record of Decision (ROD) from an Environmental Impact Statement (EIS).
Name of preparing agency: ...
Date approved:......................

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-6

Appendix A. Guidance for Supporting Photographs for EHP Grant Submissions
Photographs are a vital component of the EHP review process and add an additional level of
understanding about the nature and scope of the project. They also provide pre-project documentation of
site conditions. Please follow the guidance provided below when preparing photographs for your EHP
submission. The following pages provide examples of best practices used in earlier EHP submissions.
Minimum requirements for photographs
1. Photographs should be in color.
2. Label all photographs with the name of facility, location (city/county, state) and physical location
(physical address or latitude-longitude).
3. Label the photographs to clearly illustrate relevant features of the project, such as location of installed
features (e.g., cameras, fences, sirens, antennas, generators) and ground disturbance. See examples
below.
4. Identify ground disturbance. Adding graphics to a digital photograph is a means to illustrate the size,
scope and location of ground disturbing activities.
Best Practices
1. Provide photographs in a separate file.
2. Place no more than 2 pictures per page.
3. Compressing pictures files (such as with Microsoft Picture Manager) 1 or saving the file in pdf format
will reduce the size of the file and facilitate e-mail submissions.
4. Identify the photograph file with the project name so that it can be matched to the corresponding
FEMA EHP screening form.
5. Maximum file size for enclosures should not exceed 12 MB. If the total size of files for an EHP
submission exceeds 12 MB, send the submission in multiple e-mails.
6. If necessary, send additional photographs or data in supplemental e-mails. Please use the same e-mail
subject line with the additional label: 1 of x, 2 of x, . . . x of x.
Options for Creating Photographs
1. Obtain an aerial photo. There are multiple online sources for aerial photographs.
2. For the aerial photo, use the screen capture feature (Ctrl + Print Screen keys) and copy the image to
photo editing software, such as Paint, or PhotoShop.1 Use that software to crop the image so the
photo has the content necessary.
3. Open PowerPoint, or other graphics-oriented software, and paste the aerial or ground-level
photograph on the canvas.
4. Use drawing tools, such as line drawing and shapes, to indicate the location of project features (for
example: fencing, lighting, sirens, antennas, cameras, generators).
5. Insert text to label the features and to label the photograph.
6. Use drawing tools to identify ground-disturbing activities (if applicable).
7. Save the file with the project name or grant number so that it can be appropriately matched to the
corresponding FEMA EHP screening form. Include this file with the EHP screening when submitting
the project.
OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-7

Appendix A. Supporting Photographs for EHP Grant Submissions

Example Photographs
Aerial Photographs. The
example in Figure 1 provides
the name of the site, physical
address and proposed
location for installing new
equipment. This example of
a labeled aerial photograph
provides good context of the
surrounding area.

Figure 1. Example of labeled, color aerial photograph.

Ground-level photographs.
The ground-level photograph
in Figure 2 supplements the
aerial photograph in Figure 1,
above. Combined, they
provide a clear understanding
of the scope of the project.
This photograph has the name
and address of the project site,
and uses graphics to illustrate
where equipment will be
installed.

Figure 2. Example of ground-level photograph showing proposed
attachment of new equipment

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-8

Appendix A. Supporting Photographs for EHP Grant Submissions

Ground-level photograph
with equipment close-up.
Figure 3 includes a pasted
image of a CCTV camera that
would be placed at the project
site. Using desktop computer
software, such as PowerPoint,1
this can be accomplished by
inserting a graphic symbol
(square, triangle, circle, star,
etc.) where the equipment
would be installed. This
example includes the name and
location of the site. The site
coordinates are in the degreeminute-second format.
Figure 3. Ground-level photograph with graphic showing
proposed equipment installation.

Ground-level photograph
with excavation area closeup. The example in Figure 4
shows the proposed location
for the concrete pad for a
generator and the ground
disturbance to connect the
generator to the building’s
electrical service. This
information can be illustrated
with either an aerial or
ground-level photograph, or
both. This example has the
name and physical address of
the project site.

Figure 4. Ground-level photograph showing proposed ground
disturbance area.

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-9

Appendix A. Supporting Photographs for EHP Grant Submissions

Communications equipment
photographs. The example in
Figure 5 supports a project
involving installation of
equipment on a tower. Key
elements are identifying where
equipment would be installed on
the tower, name of the site and its
location. This example provides
site coordinates in decimal
format.

Figure 5. Ground-level photograph showing proposed
locations of new communications equipment on an existing
tower.
Interior equipment
photographs. The example in
Figure 6 shows the use of graphic
symbols to represent security
features planned for a building.
The same symbols are used in the
other pictures where the same
equipment would be installed at
other locations in/on the building.
This example includes the name
of the facility and its physical
address.

Figure 6. Interior photograph showing proposed location of new
equipment.
Ground-level photographs of nearby historic structures and buildings. Consultation with the State
Historic Preservation Office (SHPO) may be required for projects involving structures that are more than
50 years old, or are on the National Register of Historic Places. In that event, it will be necessary to
provide a color, ground-level photograph of each side of the building/structure.
1 Use of brand name does not constitute product endorsement, but is intended only to provide an example of the type of product
capable of providing an element of the EHP documentation.

OMB Control#: 1660-0115
FEMA Form: 024-0-1

A-10