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3 <br />PART 11 <br />PROJECT APPROVAL INFORMATION <br />Item 1. <br />Name of Governing Body <br />Does this assistance request require State, local, <br />? Priority Rating <br />regional, or other priority rating. <br />Yes X No <br />item 2. <br />Does this assistance request require State, or local Name of Agency or <br />advisory, educational or health clearances? Board <br />Yes X No (Attach Documentation) <br />Item 3. <br />Does this assistance request require clearinghouse (Attach Continents) <br />review in accordance with ONIB 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 />Yes X No <br />Name of Approving Agency <br />Date <br />item 5. ❑ <br />Is the proposed project covered by an approved compre_ Check one: Stale �l <br />I <br />hensive plan' Local L . <br />Regional <br />Yes X No Location of flan <br />item 6. <br />will the assistance requested serve a federal Name of Federal Installation <br />installation? Yes ie No federal Population benetitinu' front Project <br />Item 7. <br />Will the assistance requested be on Federal land or Name of Federal Installation <br />installation'. Location of federal Land _ <br />Yes X No Percent of Project _ <br />Item 8. <br />Will the assistance requested have an impact or effect See instructions for additional information to be <br />on the environment? provided. <br />Yes X No <br />Number ot: <br />Item 9. <br />\fill tile. assistance requested cause the displacement Individuals <br />of individuals, families, businesses, or farms? Families -- <br />Businesses <br />yes X No fauns <br />Item 10. <br />Is there other related assistance on this project previous, Sec instructions for additional information to be <br />pending, or anticipated? provided. <br />Yes X No <br />s <br />FORM ED -367A (2 -76) <br />uSCOMM -DC 18327 -P78 <br />