Facility Guarantee Program (FGP) Preliminary Environment

OMB Control No. #0551-0032

Expiration Date: 11/30/2022

Facility Guarantee Program (FGP) Preliminary Environmental and Social Screening Document

The information provided on this form will be used to categorize the proposed project/transaction and determine the additional information needed (if any) for FAS to evaluate the environmental and social effects of the project/transaction.

What is the project or transaction? Please give a brief description of the proposed project/transaction, including a summary of the goods and/or services to be exported.

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Estimated Guaranteed Value to be requested (USD): _____________________________

Are the products goods and/or services to be covered in your application destined for an identified physical project?

No. Please explain: what is the specific use of the goods/services if they are not intended for a specific project? (Then skip to “Project or Transaction Sector/Industry” section) ______________________________________________________________________________

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Yes, a) Identify the project:______________________________________________________

b) Provide a brief description of the project:

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c) Output and capacity/size of the project:

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d) Indicate whether this is a new project, a rehabilitation, or an expansion in size or

output of an existing project: ______________________________________________

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e) Estimated date of project completion: ________________________________________

f) Project location (physical address, including city and country): ___________________

(g) Is the project located in or near an environmentally sensitive site or area? (Check all applicable, if any):

Tropical Forests or Other Areas with High Biological Diversity
Nationally or Internationally Designated Protected Areas, such as Wetlands, Seashores, Wilde- lands or Refuges, National Parks
Habitat of Endangered Species
Location Affecting Indigenous, Tribal or Other Vulnerable Populations
Location having Historical / Archaeological Significance
Large Scale Resettlement (Potential Number of People Affected: ____________________)
Properties on the UNESCO World Heritage Site List

Project or Transaction Sector/Industry

Check classification(s) describing sector/industry of the project and/or specific goods or services:

Airport Facilities
Ports/harbors/Upgrades
Highways
Other Large Infrastructure

Transportation (please specify)

Cold Storage Facility/Refrigerated Warehouse
Pulp & Paper Plant
Flour Mill
Poultry Production/Processing Facility

Grain Discharge and Handling

Oil/Meal Processing

Warehouse Facility

Grocery Store

Beef Cattle Operations

Food Packaging and Labeling
Agricultural Production Facility

Refrigerated Trucks

Storage Bins

Other, specify: _____________________________

Name of Seller ______________________________________ Date __________________

Applicant Signature and Title__________________________________________

If the information contained on this form changes or becomes clarified after initial submission, it must be resubmitted to the FAS Credit Programs Division.

For inquiries and information please contact the FAS Credit Programs Division at (202) 720-6211.

Public Burden Statement. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The public reporting burden for this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, and completing and submitting the collection of information.