1.  Updated On:       
  2.  Approved:       

3010-FM-IWO0007    4/2014  COMMONWEALTH OF PENNSYLVANIA
Form  DEPARTMENT OF ENVIRONMENTAL PROTECTION
  INTERSTATE WATERS OFFICE
 
 
 
3010-FM-IWO0007    4/2014
Form
 
 
Initial Review:      
Updated On:      

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  Approved:         

Official Use Only
Coastal Zone Management Act
Federal Consistency Form

This document provides the Pennsylvania Coastal Resources Management Program (CRM) with a Federal Consistency Determination or Certification for activities regulated under the Coastal Zone Management Act of 1972, as amended, and NOAA’s Federal Consistency Regulations, 15 C.F.R. Part 930. Federal agencies and other applicants for federal consistency are not required to use this form; it is provided to applicants to facilitate the submission of a Consistency Determination or Consistency Certification.

I. Project/Activity Title and Reference Number:
Title:
     
Ref. No.
     
II.Applicant Contact Information:
Contact Name/Title:      
Federal Agency AND Contractor Name (if applicable):      
Mailing Address:      
City/State:       ,      
Zip Code:
     
Telephone #:
(   )      
E-mail:        
Mobile #:
(   )      
Fax #:
(   )      
III.Federal Consistency Category:
  Federal Activity or Development Project
(15 C.F.R. Part 930, Subpart C)
 
  Federal License or Permit Activity
(15 C.F.R. Part 930, Subpart D)
  Outer Continental Shelf Activity
(15 C.F.R. Part 930, Subpart E)
 
  Federal Financial Assistance to State or Local Governments (15 C.F.R. Part 930, Subpart F)
  Federal Activity with Interstate Coastal Effects
(For this category, you should also select the applicable Subpart (C, D, E, or F) from above)
(15 C.F.R. Part 930, Subpart I)

IV. Detailed Project Description (attach additional sheets if necessary):
     
V.General Analysis of Coastal Effects (attach additional sheets if necessary):
     
VI.Detailed Analysis of Consistency with CRM Enforceable Policies (attach additional sheets if necessary):
Policy 1: Coastal Hazard Areas NA
     
Policy 2: Dredging and Spoil DisposalNA
     
Policy 3: Fisheries ManagementNA
     
Policy 4: WetlandsNA
     
Policy 5: Public Access for RecreationNA
     
Policy 6: Historical Sites and StructuresNA
     
Policy 7: Port ActivitiesNA
     
Policy 8: Energy Facility SitingNA
     
Policy 9: Intergovernmental CoordinationNA
     
Policy 10: Public InvolvementNA
     
Policy 11: Ocean (Great Lakes) ResourcesNA
     
    
VI.Certification and Signature (Check one and sign below):
FEDERAL AGENCY CONSISTENCY DETERMINATION. Based upon the information, data, and analysis included herein, the federal agency, or its contracted agent, listed in (I) above, finds that this proposed activity is consistent to the maximum extent practicable with the enforceable policies of the Pennsylvania Coastal Resources Management Program.
OR
FEDERAL AGENCY NEGATIVE DETERMINATION. Based upon the information, data, and analysis included herein, the federal agency, or its contracted agent, listed in (I) above, finds that this proposed activity will not have any reasonably foreseeable effects on Pennsylvania’s coastal uses or resources (Negative Determination) and is therefore consistent with the enforceable policies of the Pennsylvania Coastal Resources Management Program.
OR
NON-FEDERAL APPLICANT’S CONSISTENCY CERTIFICATION. Based upon the inform ation, data, and analysis included herein, the non-federal applicant for a federal license or permit or state or local government agency applying for federal funding, listed in (I) above, finds that this proposed activity is fully consistent with the enforceable policies of the Pennsylvania Coastal Resources Management Program.

 
Signature:
 
 
Printed Name:
     
Date:
     
Pursuant to 15 C.F.R. Part 930, the Pennsylvania Coastal Resources Management Program must provide its concurrence with or objection to this consistency determination or consistency certification in accordance with the deadlines listed below. Concurrence will be presumed if the state’s response is not received within the allowable timeframe.

Federal Consistency Review Deadlines:

Federal Activity or Development Project
(15 C.F.R. Part 930, Subpart C)
60 days, 75 days with extension.
Additional extensions at Federal agency discretion. State and federal agency may agree to alternative time frames.
(15 C.F.R. § 930.41)
Federal License or Permit
(15 C.F.R. Part 930, Subpart D)
6 months with mandatory 3-month notification. State and applicant may agree to stay the 6-month review period.
(15 C.F.R. § 930.63)
Outer Continental Shelf Activity
(15 C.F.R. Part 930, Subpart E)
6 months with mandatory 3-month notification. State and person may agree to stay the 6-month review period.
(15 C.F.R. § 930.78)
Federal Financial Assistance to State or Local Governments (15 C.F.R. Part 930, Subpart F) 30 days from CRM-receipt of this determination.
(15 C.F.R. § 930.98)
OFFICIAL USE ONLY:
Reviewed By:       Fed Con ID:       Date Received:   /  /    
Announced in The Pennsylvania Bulletin:   /  /     Comments Received:   NO   YES
 [attach comments]
Concurrence Objection [attach details]

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