OSMRE NEPA HANDBOOK 1 JULY 2019 

APPENDIX 6.6 AML CATEGORICAL EXCLUSION DETERMINATION FORM 

(REVISED JULY 2019) 

ABANDONED MINE LANDS

CATEGORICAL EXCLUSION DETERMINATION

State: PA #

Project Name:

Project Description/Proposed Action: [Provide a detailed description of the project/proposed action (include what will be done and how)]

Yes responses require submission of an Environmental Assessment (EA).

I. GENERAL EXCEPTIONS

Does the project type specifically require an EA in 516 DM Chapter 13, as 

specified in Item I of Appendix 6.5 of OSMRE’s NEPA Handbook (2019)? No Yes 

II. DEPARTMENT OF THE INTERIOR EXCEPTIONS

Will the project have any of the following: 

1. A significant adverse effect on public health or safety? No Yes 
2. An adverse effect on any of the following unique geographic 

characteristics? If yes, check the ones that apply.

No Yes

Parks (State, Local, or National) 

Wild or Scenic Rivers

Recreation or Refuge Lands 

Wetlands 

Wilderness Areas 

Floodplains 

Ecologically Significant or Critical 

Areas Sole or Principal Drinking Water 

Prime Farmland 

Aquifers 

3. Highly controversial environmental effects? No Yes 

4. Highly uncertain and potentially significant environmental effects or

unique or unknown environmental risks? No Yes 

5. A precedent for future action or a decision in principle about future

actions with potentially significant environmental effects? No Yes

6. Directly related to other actions with individually insignificant but

cumulatively significant environmental effects? No Yes 

7. Adverse effects on properties listed or eligible for listing on the National

Register of Historic Places? No Yes

8. Adverse effects on species listed or proposed to be listed on the List of

Endangered or Threatened Species, or have adverse effects on designated

Critical Habitat for these species?

No Yes

9. Require compliance with Executive Order 11988 (Floodplain

Management), Executive Order 11990 (Wetlands Protection) or The Fish

and Wildlife Coordination Act?

No Yes 

10. Threaten to violate a Federal, State, Tribal or local law or requirement

imposed for the protection of the environment? No Yes 

11. Involve unresolved conflicts concerning alternative uses of available

resources (NEPA Sec. 102(2)(E))? No Yes

12. Have a disproportionate, significant adverse effect on low income or

minority populations (EO 12898)? No Yes

13. Restrict access to and ceremonial use of Indian sacred sites by Indian

religious practitioners or adversely affect the physical integrity of such

sacred sites (EO 13007)

No Yes 

14. Contribute to the introduction, continued existence, or spread of noxious

Weeds or non-native invasive species known to occur in the area or actions

that may promote the introduction, growth, or expansion of the range of

such species (Federal Noxious Weed Control Act and EO 13112)? 

No 

OSMRE NEPA HANDBOOK 2 JULY 2019 

Yes 
III. RESOURCE IMPACT EXCEPTIONS

Are there any unresolved issues, or adverse effects requiring specialized 

mitigation, for any of the following resources?

If yes, check the ones that apply. 

No Yes

Topography

Land Use (includes prime farmland)

Soils

Vegetation (includes wetlands)

Hydrology

Fish and Wildlife 

Historic and Cultural

Recreation

Air Quality

Noise

Other (includes socioeconomics) 

IV. ATTACH CONSULTATION LETTERS AND A LOCATION MAP

V. RESPONSIBLE OFFICIAL CERTIFICATION

Signature: 

OSMRE NEPA HANDBOOK 3 JULY 2019 

Date:

Name and Title:

VI. OSMRE DETERMINATION

This project conforms with the exclusion criteria in 516 DM Chapter 13, and is excluded 

from further NEPA compliance. 

This project does not conform with the exclusion criteria in 516 DM Chapter 13, and 

requires an Environmental Assessment. As such, OSMRE will complete an Evaluation 

of a Proposed Action template (see Appendix 4.1 of OSMRE’s NEPA Handbook (2019)). 

OSMRE Reviewer Signature: Date:

Name and Title:

Signature: Date:

Name and Title: