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U-.S.DEPARTMENT OF TRANSPORTATIOI4-fEDEh..AVIATION ADMINISTRATION OMB NO. 4-M615 <br /> 11/30/2007 <br /> PART II <br /> PROJECT APPROVAL INFORMATION <br /> SECTION A <br /> Item 1. Name of Governing Body: <br /> Does this assistance request require State, local, regional, <br /> or other priority rating? Priority: <br /> Yes Ox No <br /> Item 2. Name of Agency or Board: <br /> Does this assistance request require State, or local (Attach Documentation) <br /> advisory, educational or health clearances? <br /> Yes Ox No <br /> Item 3. (Attach Comments) <br /> Does this assistance request require clearinghouse review <br /> in accordance with OMB Circular A-95? <br /> Fx Yes F—] No <br /> Item 4. Name of Approving Agency: White River Planning & <br /> Does this assistance request require State, local, Development District <br /> regional or other planning approval? <br /> �x Yes No Date: <br /> Item 5. Check one: State <br /> Is the proposal project covered by an approved Local x <br /> comprehensive plan? Regional <br /> �x Yes E] No Location of Plan: City Hall <br /> Item 6. Name of Federal Installation: <br /> Will the assistance requested serve a Federal Federal Population benefiting from Project: <br /> installation? <br /> ❑ Yes Qx No <br /> Item 7. Name of Federal Installation: <br /> Will the assistance requested be on Federal land Location of Federal Land: <br /> or installation? <br /> Yes ❑x No Percent of Project: <br /> Item 8. See instruction for additional information to be <br /> Will the assistance requested have an impact or effect on provided <br /> the environment? <br /> Yes ❑x No <br /> Item 9. Number of: <br /> Will the assistance requested cause the displacement of Individuals: <br /> individuals, families, businesses, or farms? Families: <br /> 0 Yes Fx No Businesses: <br /> Farms: <br /> Item 10. See instructions for additional information to be <br /> � there other related Federal assistance on this rovided. <br /> ,oject previous, pending, or anti ci ted? p <br /> naYes � No <br /> FAA Form 5100-100(6-73)SUPERSEDES FAA FORM 5100-1 (9-03) Page 2 <br />