3010-FM-IWO0007 4/2014
Form
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
INTERSTATE WATERS OFFICE
Initial Review:
Updated On:
Approved:
Official Use Only
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:
E-mail:
, Zip Code:
Mobile #: ( )
Telephone #: ( )
Fax #: ( )
III. Federal Consistency Category:
Federal Activity or Development Project
(15 C.F.R. Part 930, Subpart C)
Outer Continental Shelf Activity
(15 C.F.R. Part 930, Subpart E)
Federal License or Permit Activity
(15 C.F.R. Part 930, Subpart D)
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)
Federal Financial Assistance to State or Local
Governments (15 C.F.R. Part 930, Subpart F)
IV. Detailed Project Description (attach additional sheets if necessary) :
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3010-FM-IWO0007 4/2014
Form
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
NA Policy 2: Dredging and Spoil Disposal
Policy 3: Fisheries Management NA
Policy 4: Wetlands NA
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3010-FM-IWO0007 4/2014
Form
Policy 5: Public Access for Recreation
Policy 6: Historical Sites and Structures
Policy 7: Port Activities
Policy 8: Energy Facility Siting
Policy 9: Intergovernmental Coordination
Policy 10: Public Involvement
Policy 11: Ocean (Great Lakes) Resources
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NA
NA
NA
NA
NA
NA
NA

3010-FM-IWO0007 4/2014
Form
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
NONFEDERAL APPLICANT’S CONSISTENCY CERTIFICATION.
Based upon the information, 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)
Federal License or Permit
(15 C.F.R. Part 930, Subpart D)
Outer Continental Shelf Activity
(15 C.F.R. Part 930, Subpart E)
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)
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)
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:
Announced in The Pennsylvania Bulletin
Concurrence
Fed Con ID:
: / /
Date Received: / /
Comments Received: NO
Objection [attach details]
YES
[attach comments]
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