FAST-41 INITIATION NOTICE

Indicates required field

Paperwork Reduction Act Statement – This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0316. We estimate that it will take 180 minutes to read the instructions, gather the facts, and answer these questions. Send only comments relating to our time estimate, including suggestions for reducing the burden, or any other aspects of this collection of information to:

Project Information

Title

Sector

Submit FIN form to

Project Location

Project Location Address

Project Location Address
Country Street address 1 Street address 2 City State Zip County

Project Coordinates

Coordinates

Coordinates
Latitude Enter either in decimal 51.47879 or sexagesimal format 51° 28' 43.644" Longitude Enter either in decimal -0.010677 or sexagesimal format -0° 38.4372"

Project Sponsor Contact Information


Company Name/Agency Project Sponsor Street Address City State Zip POC Name POC Title POC Work Phone POC Email Address

Alternative Point Of Contact (Optional)


Company Name/Agency Project Sponsor Street Address City State Zip POC Name POC Title POC Work Phone POC Email Address

Project Purpose

Please provide a concise overview of the purpose and objective of the proposed project.

Project Description

Please provide a concise description, including the general location of the proposed project and a summary of geospatial information, if available, illustrating the project area and the locations, if any, of environmental, cultural, and historic resources.

Technical and Financial Ability

Please provide a description regarding the technical and financial ability of the project sponsor to construct the proposed project

Summary of Financing, Reviews and Authorizations

Please provide a description of any Federal financing, environmental reviews, and authorizations to be required to complete the proposed project.

Project Assessment

Assessment that the project meets the definition of a covered project as defined in 42 U.S.C. §4370m(6)(A) of the FAST Act and a statement of reasons supporting the assessment.

Form Submitter Contact Information

Submitter Contact Information

Submitter Contact Information
Name Title Work Phone Email

Agreement

By submitting this application, I affirm that I am an authorized representative of the Sponsor indicated above and that the facts set forth in this form are true and complete.

USA Banner

FAST-41 INITIATION NOTICE