2. Were all costs incurred after clearance of the Contract Start date: environmental review and all construction-related TDA Clearance date: special conditions? Construction Contract date: 3. Is the Environmental Review Record available for Name of certifying Officer: public review? 4. Did the Grant Recipient submit a Compliance Documentation Checklist (24 CFR 58.6) with pertinent support documents? Note: This checklist is required for all levels of review. 5. Does the project description include the following: Project name, funding source and location; Use of project Size of project (sq. ft., No. of units, etc.) Type of Construction 6. Is the project description similar in quantities and locations to the Performance Statement Listed as Exhibit A in the contract? 7. Is the project description in the Environmental Review the same project that was constructed? Exempt 1. Does the ERR contain the Grant Date of Certification ___________ Recipient’s Exemption Determination for Activities Listed at 24 Eng. Contract Date_____________ CFR §58.34 certification for Engineering and Grant Mgmt. Contract Date______ Administrative/Management activities? 2. Does the ERR contain the Exemption Determination for Activities Listed at 24 CFR §58.34 Checklist, including written documentation of its determination that each activity or project is Exempt and meets the conditions specified for such exemption? 3. Did the project convert to Exempt from Categorically Excluded Subject to 58.5 under 24 CFR 58.34(a)(12)? 4. Is the original Environmental Clearance Letter from Date of Clearance: the Department for Exempt on file? ENVIRONMENTAL REVIEW Categorical Exclusion
2. Were all costs incurred after clearance of the environmental review and all construction-related special conditions? Contract Start date: TDA Clearance date: Construction Contract date: 3. Is the Environmental Review Record available for public review? Name of certifying Officer: 4. Did the Grant Recipient submit a Compliance Documentation Checklist (24 CFR 58.6) with pertinent support documents? Note: This checklist is required for all levels of review. 5. Does the project description include the following: Project name, funding source and location; Use of project Size of project (sq. ft., No. of units, etc.) Type of Construction 6. Is the project description similar in quantities and locations to the Performance Statement Listed as Exhibit A in the contract? 7. Is the project description in the Environmental Review the same project that was constructed? Exempt 1. Does the ERR contain the Grant Recipient’s Exemption Determination for Activities Listed at 24 CFR §58.34 certification for Engineering and Administrative/Management activities? Date of Certification ___________ Eng. Contract Date_____________ Grant Mgmt. Contract Date______ 2. Does the ERR contain the Exemption Determination for Activities Listed at 24 CFR §58.34 Checklist, including written documentation of its determination that each activity or project is Exempt and meets the conditions specified for such exemption? 3. Did the project convert to Exempt from Categorically Excluded Subject to 58.5 under 24 CFR 58.34(a)(12)? 4. Is the original Environmental Clearance Letter from the Department for Exempt on file? Date of Clearance: ENVIRONMENTAL REVIEW Categorical Exclusion
A1302%20-%20Self-Monitoring%20Review%20Checklist%20and%20Certification.docx