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• <br />1/31/79 AC 150/5900-1B <br />Appendix 1 <br />DEPARTMENT OF TRANSPORTATION • FEDERAL AVIATION ADMINISTRATION <br />PART II <br />PROJECT APPROVAL INFORMATION <br />Item 1. <br />Does this assistance request require State, local, Name of Governing Body <br />regional, or other priority rating? Priority Rating <br />Yes X No <br />Item 2. <br />Does this assistance request require State, or local <br />advisory, educational or health clearances? <br />Name of Agency or <br />Board <br />Yes X No (Attach Documentation) <br />Item 3. <br />Does this assistance request require clearinghouse <br />review in accordance with OMB Circular A•959 <br />X 'Yes No <br />(Attach Comments) <br />OMB NO. 80.RO 186 <br />Item 4. <br />Does this assistance request require State, local, Name of Approving Agency <br />regional or other planning approval? Date <br />Yes X No (Note: See paragraph 24a of this advisory <br />rirrinarl <br />Item 5. <br />Is the proposed project covered by an approved compre- Check one: State <br />hensive plan? Local <br />Regional <br />X Yes No Location of Plan <br />Ci (Note: See paragraph <br />J 24a of this advisory <br />(X) circular) <br />Item 6. <br />Will the assistance requested serve a Federal Name of Federal Installation <br />installation? Yes X No Federal Population benefiting from Project <br />Item 7. <br />Will the assistance requested be on Federal land or Name of Federal Installation <br />installation? Location of Federal Land <br />Yes X No Percent of Project <br />Item 8. <br />Will the assistance requested have an impact or effect See instructions for additional information to be <br />on the environment? X provided, <br />Yes <br />No <br />Item 9. Number of: <br />Will the assistance requested cause the displacement Individuals <br />of individuals, families, businesses, or farms? Families <br />Businesses <br />Yes X No Farms <br />Item 10. <br />Is there other related assistance on this project previous, See instructions for additional information to be <br />pending, or anticipated? provided. <br />Yes X No <br />FAA Fonn 5100-101 (6-73) SUPERSEDES FAA FORM 5910-1 AND 5920-1 <br />Page 2. <br />7 <br />