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<br /> 6 '/. Ii- <br /> YES NO <br /> 3. PROGRAM AMENDMENT (Change in scope or type of activities) . [J rxJ <br /> .- <br /> If.YES, the following doo.mentation must be submitted. In addition, please answer the <br /> questions listed below: <br /> Documentation required for a PROGRAM AMENDMENT: <br /> 1. Revised Parlormance Statement that indicates aU physicaJ changes in the project <br /> induding, but not limited to, changes in the project Iocation{s), number of finear feet, <br /> number of sub-activities (I.e., fire hydrants, manholes, etc.), changes' in system <br /> capacity, etc. <br /> 2, Project Map showing (a) location of original project activities and proposed <br /> acflvities; (b) original and amended target areas; and (c) geographical am covered <br /> - in the original environmental assessment. <br /> 3. local Reso1ution of support for the proposed PROGRAM AMENDMENT. <br /> Que$tions concerning the proposed Program Amendment: <br /> ÝES NO <br /> A. Changes in ScopeIType of Activity [] &J <br /> 1. Increase in Scope [ ] [Xl <br /> 2. Decrease In Scope [ ] DO <br /> 3. Change/addition of type of activity . [] Dd <br /> 4, Design modification/Change in location [ ] £x1 <br /> - .-. <br /> B. Status of Low and Moderate Income Beneficiaries YES NO <br /> 1. Is there a change in the number and/or percentage of [] {~ <br /> . tow and moderate income beneficiaries? <br /> If YES, include survey forms of the additional and/or removed beneficiaries, and document 1he <br /> amended low and moderate income beneficiaries (LMf8) in the spaces provided befow: <br /> Number of LMIB = % LMI8 I = % <br /> Total Beneficiaries - <br /> ... ' <br /> C. Re-evaluation of the Environmental Clearance <br /> YES NO <br /> 1. Does the originaJ environmental clearance indude the D4 [] <br /> geographlœl area in the proposed amendment? P1&ase <br /> indicate this geographical area on the project map. <br /> 2. Are 811 types of activities (e.g., water, sewer, streets) [x) [ ] <br /> In the proposed amendment addressed in the original <br /> environmental assessment? <br /> If a response is NO to either que$tion, please re-evaluate the original environmef1taJ <br /> -. ./ assessment and submit with this amendment request <br />