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D'EPARTMptiT OF TRANSPORTATION • FEDERAL AVIATION ADMINISTRATION <br />PART II <br />PROJECT APPROVAL INFORMATION <br />SECTION A <br />OMB NO. SO-RO184 <br />Item 1. <br />Does this assistance request require State, local, Name of Governing Body <br />regional, or other priority rating? X Priority Rating <br />Yes No <br />tem 2. <br />oes this assistance request require State, or local <br />dvisory, educational or health clearances? <br />X Yes <br />Name of Agency or <br />Board <br />No (Attach Documentation) <br />Item 3. <br />Does this assistance request require clearinghouse review (Attach Comments) <br />in accordance with OMB Circular A-95? <br />X Yes No <br />Item 4. <br />Does this assistance request require State, local, <br />regional or other planning approval? <br />R Yes No <br />Name of Approving Agency <br />Date <br />Item 5. <br />Is the proposed project covered by an approved <br />comprehensive plan? <br />X Yes No <br />Item 6. <br />Will the assistance requested serve a Federal <br />installation? x Yes <br />Check one: State <br />Local <br />Regional <br />Location of plan - <br />Name of Federal Installation <br />No Federal Population benefiting from Project <br />Item 7. <br />gill the assistance requested be on Federal land Name of Federal Installation <br />or installation? Location of Federal Land- <br />x Yes No Percent of Project <br />Item 8. <br />Will the assistance requested have on impact or effect See instruction for additional information to be <br />on the environment? provided. <br />x Yes No <br />Item 9. Number of: <br />Will the assistance requested cause the displacement of Individuals <br />individuals families, businesses, or farms? Families <br />Businesses <br />$ Yes No Farms <br />Item 10. <br />Is there other related Federal assistance on this See instructions for additional information to be <br />project previous, pending, or anticipated? provided. <br /> <br />x_Yes No <br />FAA Form 5100.100 (6-73) SUPERSEDES FAA FORM 5100-10 PAGES 1 THRU 7 Page 2