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PART 11 otra No. t0-no rat <br />PROJECT APPROVAL INFORMATION <br />(tern 1. <br />Does this ossitlonce request require Slatt, local, <br />Nome of Governing Body <br />regional, or other priority ruling? <br />Priority Rating <br />Yes No <br />Percent of Project <br />Item Z. <br />Does this assistance request require State, or local <br />Nome of Agency or <br />advisory, educational or health clearances? <br />Board <br />Yes No <br />Yet_ No <br />(Attach Documentation) <br />Item 3. <br />Will the assistance requested coute the displacement <br />Do.t this ossistance request require clearinghouse <br />(Auoch Comments) <br />review in accordance v.rlh OMB Circular A -95? <br />Yet a <br />Yet No <br />Item 4. <br />Item 10 <br />Does this ossistance requital require State, local, <br />Nome of Approving Agency <br />regional or other planning approval? <br />Dole <br />Yes No <br />Yes No <br />Item S. . <br />Is the proposed protect covered by on approved compre- Check one: State f' <br />hentive plan? Local ( 1 <br />Regional ( 1 <br />Yas No Location of Plan <br />Item 6. <br />WiII the assitloncs requested serve a Federal Nome of Federal Installation <br />installation? Yet No Federal Populotion benefiting from Project <br />Item 7. <br />Will the ostistonct requested be on Federal land or <br />Name of Federal Installation <br />instollotion? <br />Location of Federal Land <br />Yet No <br />Percent of Project <br />It.m 8. <br />Will the ossistonce requested have on impact or effect <br />See instructions for additional information to be <br />on the environment? <br />provided. <br />Yes No <br />Item 9. <br />Number of: <br />Will the assistance requested coute the displacement <br />Individuals <br />of individuals, families, businesses, or forms? <br />Families <br />Businesses — <br />Yet No <br />Forms <br />Item 10 <br />Is there other related assistants on this project previous. <br />See instructions (or additional information to be <br />pending, or anticipated? <br />provided. <br />Yes No <br />Its- it. <br />Iw the prolect in s designated flood hazard arse? <br />Sea Instructions for additional Information to <br />be provided. <br />Yee No <br />