Tribal Implementation Grants - Consolidated Workplan Template

OMB No.1093-0012

Expires: XX/XX/XXXX

U.S. Department of the Interior

Financial Assistance

Tribal Orphaned Wells Program

PROJECT NARRATIVE/WORKPLAN:

IMPLEMENTATION GRANT

(Optional Template)

Tribes may use this optional template in fulfillment the Project Narrative/Workplan (Workplan) requirement as part of application for an Implementation Grant. Mandatory elements of the required Workplan are described in Section 16E of the Phase 2 OWP Tribal Grants announcement and listed below, in the body of this document.

A Workplan may include a brief introduction and shall include sufficient information to determine whether the proposed activities are consistent with requirements described in the Phase 2 announcement.

Workplans are limited to 10 numbered pages, inclusive of all text and references and excluding this cover page, with at least 1-inch margins on all sides and 11-point font. Supporting documents may be submitted as separate attachments.

NOTE: Use this optional template only for Implementation Grant applications. A separate template for Program Development Grant applications is available in the application package for the Phase 2 announcement.

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Tribe:
Prepared by:
Submitted by:
Announcement ID:	(DOI to populate)
Proposed Period of Performance (from SF 424, item 17):

INTRODUCTION/BACKGROUND

(Optional) Provide a brief introductory or background statement about the Tribe, oil & gas activities, and any other relevant information that is not included under specific workplan elements or in the budget narrative (limit 300 words).

1. TRIBAL PROGRAM AND GRANT-FUNDED ACTIVITIES

1. Describe the Tribal program for orphaned well plugging, remediation, and reclamation/restoration, including legal authorities, processes used to identify and prioritize orphaned wells, procurement mechanisms, and other program elements

2. Describe the activities to be carried out with the grant, including an identification of the estimated health, safety, habitat, and environmental benefits of plugging, remediating, or reclaiming orphaned wells.

2. PROJECT DATA/ESTIMATES

Provide a numerical estimate and a narrative explanation, as needed, for the following data:

Number of wells and/or well sites that will be plugged, remediated, and/or reclaimed under the proposed project

(Optional narrative explanation)

Tribe’s current unemployment rate

(Optional narrative explanation)

Amount of projected costs that will be offset by forfeiture of financial assurance instruments, the estimated salvage of well site equipment, or other proceeds from the orphaned wells and adjacent land

(Optional narrative explanation)

Number of jobs that will be created or saved through the activities to be funded under this grant

(Optional narrative explanation)

Activities and costs associated with administration of the project (Limited to 10% of total grant budget. See Section D2 of Phase 2 announcement for detailed requirements.)

Provide brief description of costs or refer to detailed budget narrative:

3. PLUGGING STANDARDS

Describe the plugging standards to be applied, including planning procedures and witnessing requirements (e.g., qualifications of witness(es), documentation/ certification of work to standards). Provide a link to these standards or include the standards as an attachment in your application.

4. METHANE & GASES MEASUREMENT/TRACKING

Describe the methodology to be used to measure and track methane and other gases associated with orphaned wells, including how the Tribe will evaluate and document the effectiveness of plugging activities in reducing or elimination such emissions, specifically:

1. Pre-plugging inspection of each well or well-site included in this proposal to measure or estimate current emissions of methane, hydrogen sulfide, and other gases according to DOI’s methane measurement protocol, which can be found at: https:/www.doi.gov/sites/doi.gov/files/orphaned-wells-methane-measurement-guidelines-july-2023-version.pdf

2. Post-plugging inspection of each well or well-site included in the Tribe’s proposal that will measure and verify the lack of gaseous emissions.

3. Pre- and post-plugging inspection and measurement documentation as a verifiable record of activities and the efficacy of the work completed as part of the project.

4. GROUND- & SURFACE-WATER CONTAMINATION MEASURMENT/TRACKING

Describe the methodology to be used to measure and track ground- and surface-water contamination associated with orphaned wells, including how the Tribe will evaluate and document the effectiveness of plugging activities in reducing or elimination such contamination.

4. SITE REMEDIATION & RECLAMATION METHODS & STANDARDS

Describe the methodology to be used and standards applied to decommission or remove associated pipelines, facilities, and infrastructure and to remediate soil and habitat that has been degraded due to the presence of orphaned wells and associated infrastructure.

4. IDENTIFICATION & INVENTORY METHODS

Describe methods for identifying and inventorying undocumented orphaned wells.

4. THIRD-PARTY INVOLVEMENT

Describe plans to engage third parties (e.g., state agencies, other federal bureaus, etc.) in partnerships around well plugging and site remediation, or any existing comparable partnerships to which the Tribe currently belongs.

4. ENVIRONMENTAL COMPLIANCE

Describe how the Tribe will comply with all applicable federal statutes, regulations, and executive orders (EOs) and with all applicable Tribal, state, and local statutes and regulations to ensure that potential impacts to the environment are considered before undertaking any grant-funded action with the potential to impact the environment;, including resources and personnel who may assist with NHPA Section 106 and ESA Section 7 reviews.

4. TRAINING

Describe training programs, registered apprenticeships, and local and economic hire agreements for workers engaged in well plugging or site remediation as part of the proposed project.

4. JOB CREATION

Describe plans to support opportunities for all workers, including workers underrepresented in well plugging or site remediation, to be trained and placed in good-paying jobs directly related to the project.

4. INTERGOVERNMENTAL COORDINATION

Describe procedures and/or plans to coordinate with federal and/or State agencies to determine whether efficiencies may exist by combining field survey, plugging, or surface remediation work across private, State, federal, and Tribal land.

4. AUTHORITIES & PERMISSIONS

Describe the Tribe’s authority to enter private property, or procedures to obtain landowner consent to enter private property, in the event that any wells to be plugged will be accessed from privately owned surface.

4. PROJECT SCHEDULE/MILESTONES

Provide a work schedule with key milestones and dates for activities in the accomplishment of the proposed project.
Milestone / Task / Activity	Start Date	Completion Date

4. REQUIRED DATA ELEMENTS

Provide required data elements, including well identification number, name, type, latitude/longitude, and location accuracy, and any other available well information, such as pre-plugging emissions, and contaminants measurements, for each well or well site to be plugged, remediated, or reclaimed under the proposed project. Applicants must submit data elements using the Tribal Grant Program Data Reporting template included in the GrantSolutions announcement application kit. At minimum, applicants must complete columns A through H under the Implementation tab of the template and include with submitted application. The Tribal Program Data Reporting Template is also posted on the OWPO Tribal Program website (https://www.doi.gov/tribal-orphaned-wells-program).

https://www.doi.gov/media/document/tribal-grant-program-data-reporting-template-optional-oct-2023-xlsx

PAPERWORK REDUCTION ACT STATEMENT: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number and expiration date. The OMB control number for this template is 1093-0012 (expiration date: XX/XX/XXXX).

BURDEN ESTIMATE STATEMENT: Public reporting for this form is estimated to average 10 hours per response. Please direct comments regarding the burden estimate or any other aspect of this information collection to: U.S. Department of the Interior Information Collection Clearance Officer, 1849 C St., N.W., Washington, DC 20240.