SHPO Section 106 Consultation

THPO Section 106 Consultation*

Tribal Consultation*

USFWS Official Species Report

USFWS Section 7 Consultation

NMFS Section 7 Consultation

A. Is the resource

located within the area 

of potential effect?

B. Does the proposed

action have the potential 

to impact the resource?

YES NO YES NO C. EFFECT DETERMINATION

T&E Species or Critical Habitat

Migratory Birds

Cultural or Historic Resources

This form is available electronically.

AMS-ENV-B

(12-13-2023)

1. GENERAL INFORMATION

1A. Producer or Applicant Name and Application Number

ENVIRONMENTAL SCREENING WORKSHEET

U.S. DEPARTMENT OF AGRICULTURE

Agricultural Marketing Service

1C. Description of Proposed Action (building construction, equipment purchase, 

approximate acreage, connected actions, etc.)

1B. Location of Proposed Action (address, GPS 

location, etc.) 

2. ENVIRONMENTAL LAW AND POLICY REVIEW

4. ADDITIONAL COMMENTS

3. CONSULTATIONS AND COORDINATION

For any resource where 2B was answered “YES”, select and attach the appropriate documentation below.

5. PREPARER INFORMATION AND SIGNATURE

A. NAME OF PREPARER B. TITLE OF PREPARER

C. SIGNATURE OF PREPARER D. DATE DOCUMENT WAS PREPARED (MM-DD-YYYY)

YES NO YES NO C. EXPECTED IMPACT

Coastal Barrier Resources

Coastal Zone

Wilderness Areas

Wild and Scenic River

Nationwide River Inventory

Nationwide Natural Landmarks

Sole Source Aquifer

Floodplains

Wetlands

Highly Erodible Land

303(d) Listed Waterway

Prime and Unique Farmlands

Environmental Justice Communities

Floodplain Development Permit

FEMA Letter of Map Change

Stormwater Pollution Prevention Plan Permit 

(Construction)

National Pollutant Discharge Elimination System 

Permit (Operating)

Coastal Zone Consistency Review

State Agency Section 401 Certification

USACE Jurisdictional Determination 

USACE Section 404 Permit

Determination of Section 404 Exemption

Other Agency Coordination

Outreach to Affected Parties

Other State or Local Permitting

* These consultation or coordination efforts must be completed by the Responsible Federal Official.
THE FOLLOWING INFORMATION IS TO BE APPROVED BY THE RESPONSIBLE FEDERAL OFFICIAL OR DESIGNEE.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating 

in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, 

age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or 

funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. 

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible 

Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available 

in languages other than English. 

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any 

USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 

690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

6. RESPONSIBLE FEDERAL OFFICIAL SIGNATURE

A. NAME OF APPROVAL OFFICIAL B. TITLE OF APPROVAL OFFICIAL

C. SIGNATURE OF APPROVAL OFFICIAL D. DATE OF APPROVAL SIGNATURE (MM-DD-YYYY)

A. Is the proposed action expected to cause significant effects on public health or safety?

B. Is the proposed action expected to significantly affect unique characteristics of the geographic area such as

proximity to historic or cultural resources, listed species, wetlands, wild and scenic rivers, or ecologically critical

areas?

C. Are the effects of the proposed action on the quality of the human environment likely to be highly controversial?

D. Does the proposed action have highly uncertain effects or involve unique or unknown risks on the human

environment?

E. Does the proposed action establish a precedent for future actions with significant impacts or represent a decision

in principle about a future consideration?

F. Is the proposed action known or reasonably expected to have potentially significant environment impacts to the

quality of the human environment either individually or cumulatively over time?

6. EXTRAORDINARY CIRCUMSTANCES REVIEW YES NO

G. Is the proposed action likely to have a significant adverse effect on ANY of the resources analyzed in the

Environmental Law and Policy Review?

H. Will the proposed action threaten a violation of Federal, State, or local law or requirements for the protection of

the environment?

7. NEPA COMPLIANCE FINDING

I have reviewed and considered the types and degrees of adverse environmental impacts identified by this evaluation. I have also analyzed

the proposed action for its consistency with the National Environmental Policy Act and have considered the potential benefits of the proposal.

Based upon this consideration and balancing of these factors, I recommend one of the following:

This proposed action has been sufficiently analyzed in an existing Programmatic Environmental Assessment with a Finding of 

No Significant Impact (FONSI) and there are no predicted significant adverse environmental effects or extraordinary circumstances. 

This document is being tiered from: 

This proposed action includes activities that do not fit within the Scope of the Programmatic Environmental Assessment or has the 

potential to significantly impact a protected resource. A Site-Specific Environmental Assessment or an Environmental Impact 

Statement should be completed to provide further and more complete analysis of any adverse impacts and approval of the action 

must be delayed pending the outcome of the analysis.

Programmatic Environmental Assessment for Local Meat Capacity Grant (FONSI)

Programmatic Environmental Assessment for Organic Market Development Grant (FONSI)

Programmatic Environmental Assessment for Resilient Food Systems Infrastructure Program (FONSI)