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<br />DEPARTMENT OF TRANSPORTATION. FEDERAL AVIATION ADMINISTRATlDN <br /> <br />PROJECT APPROVAL INFORMATION <br /> <br />PART II <br /> <br />OMS NO. 80-RO 186 <br /> <br />Item 1. <br />Does this assistance request require State, local, <br />regionalf or other priority rating? <br />_Yes~No <br /> <br />Name of Governing Body <br />Priority Rating <br /> <br />Item 2. <br />Does this assistance request require Stote, or local <br />IIsorY1 educational or health clearances? <br /> <br />_Yes~No <br /> <br />Nome of Agency or <br />Boord <br /> <br />(Attach Documentation) <br /> <br />Item 3. <br />Does this assistance request require clearinghouse <br />review in accordance with OMB Circular A-95? <br /> <br />~Yes~o <br /> <br />(Attoch Comments) <br />Comments from CAPCO will be <br />forwarded by separate mail. <br /> <br />Item 4. <br />Does th i 5 as si stance request requ ire State, loco\, <br />regional or other planning approval? <br />_Yes~No <br /> <br />Nome of Approving Agency <br />Date <br /> <br />I'em 5. <br />Is the proposed project covered by on approved compre- <br />hensive pIon? <br /> <br />_Yes~No <br /> <br />Check one: State <br />Locol <br />Regional <br />Location of Plan <br /> <br />[I <br />iJ <br />[-1 <br /> <br />Item 6. <br />Will the assistance requested serve a Federal <br />installation? _ Yes ~No <br /> <br />Nome of Federal Installation <br />Federal Population benefiting from Project <br /> <br />17. <br />, the assistance requested be on Federal land or <br />al/ation? <br />_ Yes~No <br /> <br />Name of Federal Installation <br />Location of Federal Land <br />Percent of Proiect <br /> <br />Item 8. <br />Will the assistance requested hove an impacf or .eHect <br />on the environment? <br /> <br />_Yes~No <br /> <br />See in structions for additional information to be <br />provided. <br /> <br />Item 9. <br />Will the assistance requested cause the displacement <br />of individuals, families, businesses, or forms? <br /> <br />______Yes~No <br /> <br />Number of: <br />Individual s <br />Families <br />Businesses <br />Farms <br /> <br />Item 10. <br />Is there other related assistance on this proiect previous, <br />pending, or anticipated? <br /> <br />_ Yes ---X...- No <br /> <br />See instructions for additional information to be <br />provided. <br /> <br />Page 2 I <br /> <br />FAA Form,5100-101 \6-731 SUPERSEDES FAA FORM 5910-1 AND 5920-1 <br /> <br />.~~~~~~~~~$~~~~~~~j~f~2:~~::::::~:::~:?'~~~~:::.- <br />