FORM - A
Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
PART - I
(To be filled up by User Agency)
A.
General Details
A-1.
Project Details
(i). Proposal No. :
FP/RJ/DISP/64500/2020
(ii). Name of Project for which Forest Land is required :
Constriction of Primary Health Centre at Village Paada , Tehsil Rajgarh , District -Alwar
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Constriction of Primary Health Centre at Village Paada , Tehsil Rajgarh , District -Alwar , Rajasthan Forest Diversion Area= 0.3128 ha. Done
(iv). State :
Rajasthan
(v). Category of the Proposal :
Dispensary/Hospital
(vi). Shape of forest land proposed to be diverted :
Non Linear
(vii). Estimated cost of the Project(Rupees in lacs) :
185
(viii). Area of forest land proposed for diversion(in ha.):
0.16
(ix). Non-forest land required for this project(in ha.):
0
(x). Total period for which the forest land is proposed to be diverted(in years):
99
A-2.
Details of User Agency
(i). Name :
MEDICAL, HEALTH AND FAMILY WELFARE DEPARTMENT RAJASTHAN
(ii). Address1 :
Swasthya Bhawan , Tilak Marg,Jaipur
(iii). Address2 :
NIL
(iv). State :
Rajasthan
(v). District :
Jaipur
(vi). Pin :
302005
(vii). Landmark :
Ashok vihar park
(viii). Email address :
phcfca2020@gmail.com
(ix). Landline Telephone No. :
141-222576
(x). Fax No. :
141-
(xi). Mobile No. :
9571778899
(xii). Website (if any) :
NIL
(xiii). Legal status of User Agency :
State Government
A-3.
Details of Person Making Application
(i). First Name:
Bharosi
(ii). Middle Name:
Lal
(iii). Last Name:
Meena
(iv). Gender:
Male
(v). Designation:
ExecutiveEngineer
(vi). Address 1:
Executive Engineer , Medical and Health Division-Alwar, CMHO office Nangali Circle Alwar
(vii). Address 2:
NIL
(viii). State:
Rajasthan
(ix). District:
Alwar
(x). Tehsil:
Alwar
(xi). Pin:
301001
(xii). Landmark:
NIL
(xiii). Email Address:
phcfca2020@gmail.com
(xiv). Landline Telephone No.:
0-
(xv). Fax No.:
NIL
(xvi). Mobile No.:
9950919192
(xvii). Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency:
B.
Details of land required for the Project
B-1.
Details of proposal seeking prior approval of Central Government under the Act for diversion of forest land for the Project already submitted in the past
List of proposal submitted in Past
S.no
Proposal Status.
Proposal No.
Moef File No.
Area Proposed for Diversion(Ha.)
Area Diverted(Ha.)
Date of In-Principle Approval
Date of Final Approval
NIL
B-2.
Details of forest land proposed to be diverted
B-2.1
Details of Divisions involved
Details of Divisions involved
S.no
Division Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
Alwar Territorial
0.16
0
Total
0.16
0
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
Alwar
0.16
0
Total
0.16
0
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Village-Paada
0.16
0
Total
0.16
0
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Construction of Primary Health Centre
0.16
0
Total
0.16
0
C.
Maps of forest land proposed to be diverted
Division 1. : Alwar Territorial
(i). Area of forest land proposed to be diverted(in ha.) :
0.3128
(ii). Nature of the Project:
Non Linear
(a). No. of patches :
One
Patch wise details
Patch No.
Area of Patch(in ha.)
Kml File of Patches
To view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.
0.16
View File
(iii). Copy of Survey of India Toposheet indicating boundary of forest land proposed to be diverted:
(iv). Scanned copy of the Geo-referenced map of the forest land proposed to be diverted prepared by using GPS or Total Station:
D.
Justification for locating the Project in forest land and details of alternatives examined:
(i). Copy of note containing justification for locating the Project in forest land:
E.
Employment likely to be generated
(i). Whether the Project is likely to generate employment ?:
Yes
(ii). Permanent/Regular Employment(Number of persons):
12
(iii). Temporary Employment(Number of person-days):
150
F.
Displacement of People due to the Project, if any
(i). Whether Project involves displacement?:
No
G.
Details of Cost-Benefit analysis for the Project
(i). Whether the Project requires Cost-Benefit analysis?:
No
H.
Status of Environmental Clearance
(i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? :
No
I.
Status of Wildelife Clearance
(i). Whether the Project or a part thereof is located in any Protected Area or their Eco sensitive zone? :
No
J.
Applicability of special provisions governing Scheduled Areas
(i).Whether the Project or a part thereof is located in a Scheduled Area? :
No
K.
Status of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted
(i). Whether the process for settlement of Rights under the Forest Rights Acts 2006 on the forest land proposed to be diverted has been completed? :
Yes
(a). Copy of documentry evidence in support of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted:
L.
Details of land identified for Compensatory Afforestation
(i). Whether non-forest or Revenue forest land is required to be provided by User Agency?:
Not Applicable
(ii). Whether the area of non-forest land or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation is less than area of forest land proposed to be diverted ?:
Not Applicable
(iii) . Reason for not providing Non-Forest Land:
Not Applicable
Additional information Details
Documents
S.No
Documents
Remarks
1
AUTHORIZATION LETTER
2
Administrative and Financial Sanction
3
Project Report
4
EDS Reply Letter-8-12-2020
5
EDS Reply-14-07-2021
6
EDS REPLY LETTER-30-07-2021
7
BUILDING PLAN OF PHC
8
Certificate of non-availability of non-forest land by District Collector
9
EDS REPLY LETTER ALWAR -18-09-2021
10
EDS REPLY-20-12-2021
11
No alternative Land Available Letter by District Collector Alwar
12
Undertaking for 100% forest land Use in this Proposal
13
EDS Reply-20-05-2022
14
Revised Authorization Letter
15
Technical Sanction
16
Alternative PHC Alignment Analysis Sheet
17
Khasra Map and Jamabandi Certified
18
JUSTIFICATION FOR LOCATING THE PROJECT IN FOREST AREA
19
Details of Permanent Employment to be Generated
20
CERTIFICATE FOR MINIMUM USE OF FOREST LAND
21
STATEMENT SHOWING DETAILS OF FOREST AREA PROPOSED FOR DIVERSION
22
UNDERTAKING FOR CONSERVATION OF FLORA-FAUNA AND WILDLIFE
23
UNDERTAKING FOR FRA CERTIFICATE
24
UNDERTAKING FOR MUCK DISPOSAL DURING CONSTRUCTION OF PHC
25
UNDERTAKING FOR NO CHANGE S IN STATUTORY POSITION OF DIVERTED FOREST LAND
26
UNDERTAKING FOR PAYMENT OF ANY OTHER COST - CONDITION
27
UNDERTAKING FOR PAYMENT OF COST OF COMPENSATORY AFFORESTATION
28
UNDERTAKING FOR PAYMENT OF NET PRESENT VALUE OF FOREST AREA
29
UNDERTAKING FOR USE OF ANY MATERIAL FROM SURROUNDED FOREST LAND
30
UNDERTAKING FOR WASTE MANAGEMENT DURING CONSTRUCTION ACTIVITY
31
Khasra Map Super Imposed Scale 1 : 4000
32
Geo-Referenced Survey of India Topo Sheet With Proposed PHC Full Toposheet No 54A-11 Scale 1 : 50000
33
Geo-Referenced DGPS MAP with Required Forest land coordinate and Proposed PHC
34
Alternative Toposheet Map Scale 1 : 50000
35
Alternative Route Digital Map
36
COMPARATIVE STATEMENT OF ALTERNATIVE ROUTE
37
EDS Reply-20-10-2022
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