What is the Short Environmental Assessment Form for?

It collects project information and supports an agency's environmental review of an unlisted action, including assessment of potential effects and their significance.

Who completes this form?

The applicant or project sponsor completes Part I. The agency completes Part II, and the lead agency completes Part III.

Do I need a notary for the Short Environmental Assessment Form?

No. The applicant certifies, signs, and dates Part I without a notary; agency officials sign the later determination.

Champion, NY · Jefferson County

No notary required

Short Environmental Assessment Form

Applicants or project sponsors complete Part I to provide project details for an environmental assessment of an unlisted action.

What this form is

This form gathers project information for an environmental assessment of an unlisted action. The applicant or project sponsor completes Part I with details such as the project location, proposed action, land affected, zoning, and related permits or approvals. The agency completes the environmental assessment and determination sections, including its review of potential impacts and the significance of those impacts.

Who needs it

An applicant or project sponsor uses Part I to provide information about a proposed unlisted action for agency environmental review.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This document is signed without a notary; the applicant certifies, signs, and dates Part I, and agency officials sign the later determination.

How to submit this form

1
Download The Form
Download the Short Environmental Assessment Form PDF.
2
Complete Part I
The applicant or project sponsor provides project details and certifies, signs, and dates Part I.
3
Add Supporting Materials
Add attachments or supporting materials if needed to explain the assessment, as the form instructs.
4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What is the Short Environmental Assessment Form for?: It collects project information and supports an agency's environmental review of an unlisted action, including assessment of potential effects and their significance.
Who completes this form?: The applicant or project sponsor completes Part I. The agency completes Part II, and the lead agency completes Part III.
Do I need a notary for the Short Environmental Assessment Form?: No. The applicant certifies, signs, and dates Part I without a notary; agency officials sign the later determination.
How do I submit the Short Environmental Assessment Form?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Short Environmental Assessment Form doesn’t need a notary — but if you have another Champion form that does, a commissioned online notary can help.