State Grants Consolidated Workplan Template

OMB No. 1093-0012
Expires: XX/XX/XXXX

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WORK PLAN/PROPOSAL FOR MATCHING GRANT FUNDS
(Suggested Format)
Instructions: A Matching Grant application Work Plan/Proposal for Matching Grant Funds
(Work Plan) should thoroughly address each element in Sections III.C.6.d. and V.B. of the
Matching Grant Guidance (Guidance). This template is provided to assist States in
preparing a Work Plan that addresses the required elements in the Guidance. States are
not required to use this template. However, if a State does not use this template, it should
ensure that its Work Plan addresses each required element in the Guidance. The Work
Plan must justify the Matching Grant amount, which is the Certified Amount less the
Average 2010-2019 Amount. Please carefully complete each section below, and use additional
sheets as needed. Please use at least an 11-point font.
The template outline of suggested sections in the work plan/proposal is shown in standard font.
The italicized font portion provides descriptions of the information that should be included
within each section and covers all of the required elements of the program guidance. References
to the specific subsection of the program guidance to be addressed are also included within each
section of the template.
Person Submitting Proposal:

Date:

Organization Name:
Announcement ID: D-AQD-FA-25-002-111198 / D-AQD-FA-25-002

Applicant Program Title:
Estimated Period of Performance: This should match item 17 of the SF-424.
Proposed Locations:
PROJECT/PROGRAM ABSTRACT: (Include completed Form OMB 4040-019 with
Application)
Prepare a project abstract of not more than one page that will include the project purpose,
activities to be performed, expected deliverables or outcomes, intended beneficiaries, and
subrecipient activities (if known). The abstract should be included in a completed Form OMB
4040-019 and is limited to 4,000 characters or less. [Guidance Section IV.C.2.]
WORK PLAN/PROPOSAL:
The proposed work plan outline topics listed in this section cover all of the required elements of
the Work Plan as described in the Guidance Section IV.C.5.d., as well as the Standards for
Measurement, Plugging, Remediation, and Workforce described in Section VI.B. Each section
below identifies the specific subsections of the program guidance where the elements included in
each topic are described.

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Orphan Well Program Description
Provide a description of the State program for orphaned well plugging, remediation, and
restoration, including legal authorities, processes the State currently uses to identify and
prioritize orphaned wells, procurement mechanisms, and other program elements demonstrating
the readiness of the State to carry out proposed activities using the grant, including summary
descriptions: Guidance Section IV.C.5.d.i.aa


The definitions and processes used by the State to formally identify a well as— a. an
orphaned well; or if the State uses different terminology, otherwise eligible for plugging,
remediation, and reclamation by the State. Guidance, Section IV.C.5.d.iv.



The State’s plugging standards, including the witnessing requirements (qualifications of
witnesses, documentation); If the state has no plugging standards, describe how the work
performed will reflect, at a minimum the Bureau of Land Management’s Onshore Oil and
Gas Order No. 2 (for onshore wells) or the relevant provisions of 30 CFR Part 250 (for
offshore wells). Guidance, Sections IV.C.5.d.i.aa.l, VI.B.2.



How salvaged material and equipment will be reused, recycled, or sold for scrap (with any
resulting income reported to DOI and incorporated into the grant budget for eligible
activities upon approval by DOI). Guidance, Section IV.C.5.d.i.aa.ll.



The State’s authorities to enter private property, or a State’s procedures to obtain landowner
consent to enter such property, and in the event that any wells to be plugged will be accessed
from federal or Tribal land, how the State will gain access. Guidance, Section
IV.C.6.d.i.aa.lll.



The process the state follows to identify and pursue all potentially responsible parties that
may be legally liable for plugging, remediating, or restoring orphaned wells in the state.
Guidance, Section IV.C.5.d.i.hh.



The means by which the information regarding the activities of the State under this grant will
be made available on a public website. Guidance, Section IV.C.5.d.i.gg.



How the State will use funding to locate currently undocumented orphaned wells. Guidance,
Section IV.C.5.d.x.



Plans the State has to engage third parties in partnerships around well plugging and site
remediation, or any existing similar partnerships the State currently belongs to. Guidance,
Section IV.C.5.d.xi.

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Summary of Well Prioritization Process


Describe how the State will prioritize (i.e., rank for remediation activity) orphaned wells
based on resolving environmental injustices, threats to public health and safety,
environmental harm – particularly harms due to methane emissions – and other land use
priorities, including the remediation of hazardous sites in disadvantaged communities. This
includes how the State will place a higher priority to use federal funds to lower
unemployment in the State, including workforce development activities directly related to
orphaned well plugging, remediation, and reclamation. And, how the State will place a
higher priority to use federal funds to improve economic conditions in economically
distressed areas of the State, provided that the use of the funds is directly related to orphaned
well plugging, remediation, and reclamation. Guidance, including workforce development
activities, Section IV.C.5.d.i.bb-dd.



Provide details of how the State will identify and prioritize the highest methane emitters and
how the State will identify and prioritize well plugging and site reclamation that are intended
to reduce health or environmental burdens for environmental justice communities and other
disadvantaged communities (as identified through CEJST), such as through plugging wells
and remediating sites within 0.5 miles of a disadvantaged community. The State may also
identify and factor into its prioritization orphaned wells within 0.5 miles of disadvantaged
communities, as identified by the CEJST. The State may also identify and address how it will
address any disproportionate burden of adverse human health or environmental impacts of
orphaned wells on local communities with environmental justice concerns and other
disadvantaged communities, including but not limited to low-income communities and Tribal
(with or without land) or other similar communities, consistent with all applicable legal
requirements. Decision points and underlying assumptions, such as the number and type of
environmental indicators, must be described in the application. Guidance, Section
IV.C.5.d.v-vi.

Public Outreach for Well Prioritization
Methods the State will use to solicit recommendations from local officials and the public
regarding the prioritization of well plugging and site remediation activities, and any other
processes the State will use to solicit feedback on the program from local governments and the
public. Guidance, Section IV.C.5.d.ix.
Pre-and Post-Plugging Measurement of Emissions of Methane and Other Gasses
Describe how the state will perform pre- and post-plugging inspections of wells and
measurement of emissions of methane and other gases, including whether the work will be
performed by state personnel or contractors, training of personnel to perform the measurements,
the technical methodology to be used, and how the methodology meets the minimum standard of
the DOI methane measurement guidelines. Guidance, Section VI.B.1.

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Site Remediation & Restoration


Describe the state’s program for conducting remediation of contaminants in soil, water, or
other medium resulting from orphaned well and the process and describe applicable state or
federal laws, regulations, or authorities that are applicable. Guidance, Section VI.B.2.d.



Describe the methodology, including field indicators, sampling, and modeling approaches, to
be used by the State to measure and track contamination of groundwater and surface water
associated with orphaned wells, including how the State will assess the effectiveness of
plugging activities in reducing or eliminating such contamination. Guidance, Section
IV.C.5.d.vii.



Describe methods to be used to decommission or remove associated pipelines, facilities, and
infrastructure and to remediate soil and restore habitat that has been degraded due to the
presence of orphaned wells and associated infrastructure, including a description of how
salvaged material and equipment will be reused, recycled, or sold for scrap (with any
resulting income reported to DOI). Guidance, Section IV.C.6.d.viii.



Describe a plan to monitor the reclaimed locations to ensure remediation and reclamation
success. Such plan should include methodology and chronology of monitoring, data
collection, and a plan for additional reclamation should the initial attempt be unsuccessful.
The activities outlined in the plan should be incorporated into the preliminary work schedule
and description of milestones in the work plan as well. Guidance, Section IV.C.6.d.xv.



Describe state standards for well abandonment, including actions necessary to complete
surface reclamation and revegetation. If the state does not have well abandonment
standards, describe how the state will meet the BLM Reclamation and Abandonment
Standards for well sites where appropriate. Guidance, Section VI.B.2.a. and c.

Workforce Development & Related Activities


Describe any plans the State has to support opportunities for all workers and vendors,
including workers underrepresented in well plugging or site remediation, workers in
traditional energy communities impacted by changing markets and technology, and workers
from disadvantaged and underserved communities to be trained and placed in good-paying
jobs directly related to the activities funded by the grant, including through workforce
development programs. Guidance, Section IV.C.5.d.xii.



Provide a description of:
1. Training programs, including pre-apprenticeships, registered apprenticeships, local and
economic hire agreements for workers, and engagement with relevant labor unions with
which the State intends to conduct outreach, partner, or fund in well plugging or site
remediation;

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2. Plans the State may or may not have to use procurement processes that incentivize
contractors to hire current or former employees of the oil and gas industry;
3. Whether the State plans to bundle and aggregate activities into larger state-wide or
regional contracts as part of their procurement processes;
4. Whether the State plans to support safe, equitable, and fair labor practices by adopting,
requiring, or encouraging contractors to adopt collective bargaining agreements, local
hiring provisions, labor agreements, and community benefits agreements; and
5. Whether, and if so, how, the State plans to use a program to help determine if a
contractor is “responsible,” such as a responsible contractor ordinance, prequalification requirements or similar programs.
Guidance, Section IV.C.6.d.xiii.


Indicate If you intend to implement any of the recommended Workforce Standards described
in Guidance, Section VI.B.3., and if so, describe how the State will do so.

Federal and Tribal Coordination
Describe procedures the State will use to coordinate with federal or Tribal agencies to determine
whether efficiencies may exist by combining field survey, plugging, or surface remediation work
across private, State, federal, and Tribal land. Guidance, Section IV.C.6.d.xiv
Work Plan Activities, Milestones & Schedule
Task/Activity Description


Provide a description of the details of each activity to be carried out with the grant,
including a preliminary work schedule covering the period of performance of the Matching
Grant. Each activity must include a schedule and resources needed for getting the work
completed, which must cover the entire relevant period. Guidance, Section IV.C.5.d.i.ee.



Describe what tasks will be performed by partner organizations, sub-awards, contractors,
and consultants, if applicable. Guidance, Section IV.C.5.d.i.ee.



Identify proposed performance goals including a schedule of milestones for completing the activities
described above and to achieve the objectives of the workplan, in a table (a suggested example is
shown below), or through other graphical aids, work schedule, Gantt chart, etc. Guidance, Section
IV.C.5.d.i.ff.



Describe any existing process established to conduct environmental reviews for compliance
with Section 7 of the Endangered Species Act and Section 106 of the National Historic
Preservation Act and to document compliance prior to initiating any ground-disturbing field
work. If no current process exists, describe how such a compliance program will be
established for review of grant activities, including use of consultants, other state agencies or
other partners, as well as steps to be undertaken to identify Indian tribes that may have

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interest in historic or cultural resources in areas where work may be performed under the
grant. Guidance, Section IV.C.5.d.i.ee and Section VI.C.3-4.


Describe any process and/or information that will be used to support environmental
compliance review requirements other than ESA or NHPA requirements. Guidance, Section
IV.C.5.d.i.ee.

Estimate of Program Outcomes


Public Benefit and Program Interest: Identify the estimated health, safety, habitat, and
environmental benefits of plugging, remediating, or reclaiming orphaned wells. Guidance,
Section IV.C.5.d.i.ee.



Provide an estimate, which the Department acknowledges is a snapshot in time and subject
to change as circumstances on the ground dictate, of Guidance, Section IV.C.5.d.ii.:
1. The number of orphaned wells or sites, categorized by the region in the State that the
State forecasts may be plugged, remediated, or reclaimed using Matching Grant funds.
2. The projected cost, including the basis of estimates, of—
a. Plugging, remediating, or reclaiming orphaned wells;
b. Remediating or reclaiming adjacent land; and
c. Decommissioning or removing associated pipelines, facilities, and infrastructure.
3. The amount of that projected cost that will be offset by the forfeiture of financial
assurance instruments, the estimated salvage of well site equipment, or other proceeds
from the orphaned wells and adjacent land.
4. The number of jobs that will be created or saved through the activities to be funded under
this grant and the assumptions and methodology to develop the estimate.
5. To the extent possible, the miles and diameter(s) of associated pipelines and number and
description of associated facilities and infrastructure assets that will be decommissioned
or removed.

Identification of Wells to be Plugged, Remediated, or Reclaimed
If practical, identify the latitude/longitude, type of well, the well ID (API number), surface
ownership, and mineral ownership for those wells that are likely to be plugged, remediated, or
reclaimed. Guidance, Section IV.C.5.d.iii.

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Timeline or Milestones to Complete Expected Results [Suggested table below]:
Describe significant outputs and expected results or outcomes of the activities with a clear set of
milestones and how they will be measured within a specified timeframe. All proposals must have
measurable results that correlate to a timeline.
Milestone / Task / Activity
Insert specific, measurable results/outcomes such as
milestone, task, and/or activity, e.g., initiate and
complete well prioritization, initiate and complete
procurement of contractors, initiate and complete ESA
and NHPA review activities, begin field work plugging
wells, number of acres surveyed in x county/area; the
number of wells plugged, remediated, or restored; the
number of acres reclaimed or remediated; draft or final
report to be disseminated to the public; and/or number of
public outreach events (identify types of events) as
applicable.

Start Date

Completion Date

Performance Monitoring and Evaluation Plan
Describe how you will measure performance and assessment tools to be used and how you will
evaluate the performance of sub awards, subrecipients, contractors etc.
Qualifications




List key personnel and responsibilities (e.g., Principal Investigator/Program Director and
Administrative Official/Authorized Representative) and describe their experience and
qualifications that are appropriate to the success of the State’s program.
List contractors, sub-awards, and consultants, if known, and their qualifications.
List personnel and or contractors/consultants, if known, who will be performing required
ESA and NHPA reviews and their qualifications.

Leveraging of Resources (optional, if applicable)
If the State has any plans to leverage funds or resources with other federal and/or non-federal
sources of funds or resources to carry out the proposed activities, please describe those plans.
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20240.