CE Determination Form
Project Identification
Highway: Enter highway here
County: Choose an item.
District: Choose an item.
Associated CSJs: Enter associated CSJ numbers
CSJ #: Enter CSJ Number
Limits/From: Enter Limits/From
Limits/To: Enter Limits/To
Select the specific CE:
(c) List
Choose an item.
(d) list
Choose an item.
Proposed CE Determination (This section to be signed by a TxDOT staff member on behalf of the department delegate.)
By my signature below, I confirm that I have reviewed the project file and I have determined that:
The project does not involve unusual circumstances, leading to significant environmental impacts, including:
 Significant impacts to planned growth or land use for the area
 Relocation of significant numbers of people
 Significant impacts on any natural, cultural, recreational, or other resource
 Significant air, noise, or water quality impacts
 Significant impacts on travel patterns’
 Other impacts which, individually or cumulatively, have significant environmental impacts
The project does not involve substantial controversy on environmental grounds
The project will not have a significant impact on properties protected by Section 4(f) of the DOT Act or Section 106 of the National Historic
Preservation Act.
The project does not involve any inconsistencies with any Federal, State, or local law, requirement, or administrative determination relating
to the environmental aspects of the action.
Reviewed by:
Enter Reviewer Name
Title: Enter Reviewer Title
Date: ________________________________
______________________________________________________________
Signature
Peer Review (Complete this section ONLY for (d)-list Categorical Exclusions. This section is to be signed by an independent TxDOT reviewer.)
I certify that I did not prepare the CE documentation for this project, and I have reviewed the project file documentation and the proposed
determination, and I concur that the project is appropriately classified.
Reviewed by:
Enter Peer Reviewer Name
Title: Enter Peer Reviewer Title
Date: ________________________________
______________________________________________________________
Signature
Final CE Determination (The person with approval authority for the project completes this section.)
Select the correct determination below:
Determination of Categorical Exclusion for a Project Assigned to TxDOT by FHWA
The State has determined that this project has no significant impact(s) on the environment and that there are no unusual circumstances as
described in 23 CFR 771.117(b). As such, the project is categorically excluded from the requirements to prepare an environmental
assessment or environmental impact statement under the National Environmental Policy Act. The State has been assigned, and hereby
certifies that it has carried out, the responsibility to make this determination pursuant to Chapter 3 of Title 23, United States Code, Section
326 and a Memorandum of Understanding dated December 6, 2013, executed between the FHWA and the State.
Determination of Categorical Exclusion for a State Project
This project will have no significant impacts on the environment. I approve this project as a categorical exclusion.
Project Not Assigned to TxDOT by FHWA
The State has determined that this project is not a project type assigned to the State by FHWA, and determines that this project is ready for
FHWA review.
Approved by:
Enter Approver Name
Title: Enter Approver Title
Date: ________________________________
______________________________________________________________
Signature
Form
TxDOT Environmental Affairs Division
Release Date: May 2014
Version 2
130.01.FRM
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