To submit this form, send it directly to the District Engineer having jurisdiction over your project area. You can email your completed form and any attachments to the appropriate office. Alternatively, you may submit the form via fax or through traditional mail to the address specified in the guidelines.

The approved form has an expiration date of 02-28-2022. New modifications to the form or regulations may take effect the following years, with updates anticipated in 2024 and 2025. Ensure you check for the most recent guidelines and amendments to stay compliant.

The purpose of this form is to ensure that all necessary information regarding proposed activities affecting wetlands or navigable waters is collected. It aids regulators in assessing potential environmental impacts and compliance with the Clean Water Act. Completing this form is a critical step in obtaining the required permits for construction activities.

• 1. APPLICATION NO.: Unique identification number for the application.
• 2. FIELD OFFICE CODE: Code identifying the field office handling the application.
• 3. DATE RECEIVED: Date the application was received by the Corps.
• 4. DATE APPLICATION COMPLETE: Date when the application was deemed complete.
• 5. APPLICANT'S NAME: Full name of the applicant requesting the permit.
• 6. AUTHORIZED AGENT'S NAME: Name of the authorized agent, if applicable.
• 7. APPLICANT'S ADDRESS: Mailing address of the applicant.
• 8. AGENT'S ADDRESS: Mailing address of the agent, if applicable.
• 9. APPLICANT'S PHONE NOs.: Contact numbers for the applicant.
• 10. DESCRIPTION OF PROJECT OR ACTIVITY: Description of the proposed project, including location and nature of activities.

If the form is not submitted, the permit application cannot be evaluated or approved. This could delay the project and result in potential penalties or re-evaluation requirements.

• Delayed Permitting Process: Failure to submit the form can lead to significant delays in starting your project.
• Non-compliance Issues: Not completing the form could result in non-compliance with federal regulations.
• Financial Implications: Delays in the application process may lead to increased costs.
• Loss of Credibility: Inadequate submission may affect your reputation with regulatory agencies.
• Increased Environmental Risks: Without proper submissions, there may be environmental impacts that go unassessed.

• 1. Construction Projects Impacting Waterways: Use this form when planning construction near water bodies.
• 2. Land Development Near Protected Areas: Required for land development activities near wetlands or protected areas.
• 3. Infrastructure Projects Requiring Federal Oversight: Use when federal permits are needed for bridge or road construction.
• 4. Dredging and Filling Activities: Necessary for any activities that involve dredging or filling in water bodies.
• 5. Maintenance Projects in Sensitive Environments: Needed for ongoing maintenance of infrastructure affecting sensitive water environments.