SECTION 1 – Landowner/Plan Preparer Information
Landowner Name:	County:
Plan Preparer:	TSP ID:
Plan Reviewer:	Review Date:
Plan Type:	CPA 106	DIA 165	CPA 106 & DIA 165
SECTION 2 – Introduction
Conservation Planning Activity (CPA 106) Forest Management Plan is a tract-specific conservation plan that contains planned forest related conservation management activities addressing for one or more resource concerns. A Design and Implementation Activity (DIA 165) Forest Management is the designing of conservation management practices found in a tract-specific Forest Management Plan (CPA 106) or that address the planned practices in a conservation plan to meet conservation objectives.
SECTION 3 – Deliverables
Two copies of the CPA 106 and/or DIA 165 must be developed, one for the landowner and one for the NRCS field office. The NRCS copy must include all applicable items in this checklist. The landowner’s copy must include: For a CPA 106 – the maps and preferred alternative. For the DIA 165 – implementation requirement/specifications. Other applicable items in the checklist as requested by the client.
SECTION 4 – Forest Management Plan Component Review Checklist
These tables below detail the minimum criteria to be addressed by a Forest Management Plan (CPA 106) and a Forest Management DIA (DIA 165). Additional information, such as tax information, a glossary, etc., should be considered for inclusion as well. This checklist can be used as a tool for both plan preparers and reviewers. A circle () in the “CPA” column or triangle () in the “DIA” column indicates which criteria are required for each activity type. If a plan is written for both activities, all applicable items below are required.
SECTION 5 – VDOF Plan Reviewer
If the component is included and acceptable, mark with Y in the second or fourth column. If the component is not included or not acceptable, mark with N in the second or fourth column.
Property Identification and Overview (include on cover page(s))	CPA	Y/N	DIA	Y/N
1.	Client and Site Information
a.	Client name
b.	CPA Property name, if different than clients name
c.	Farm name and owner name (if different than clients name), street address of farm (if available), county, and state
d.	Client primary phone number
e.	Farm Bill program, contract number, and contract item number
f.	Client signature and date
g.	Land use(s)
2.	Technical Service Provider Information
a.	TSP’s name, address, phone number, and contract item number
b.	TSP number, TSP expiration date, and county of service
c.	Required TSP Statement¹
d.	TSP’s signature and date
Property Identification and Overview, continued	CPA	Y/N	DIA	Y/N
3.	Other Information
a.	List of all practice designs included in the DIA
b.	Block for NRCS acceptance, including signature and date
Maps	CPA	Y/N	DIA	Y/N	N/A
4.	Maps*
a.	General location map on the planning/implementation area
b.	Forest management plan base map (this may consist of several maps to account for the entire planning area). Include: Boundary lines for the property ownership Acreage for the property ownership Forest stand boundaries Unique identifying code for each forest stand Location of sensitive resources and setbacks, if applicable Location of planned and applied conservation practices If the planning area includes non-private lands, such as Federal or Tribal lands, include ownership categories.
c.	Soils map
d.	Other applicable resource maps
e.	An existing wetland delineation map, if any
*At minimum, all maps developed for the CPA or DIA will include:
1.	Title block showing: map title; client’s name (individual or business); “Prepared with assistance from USDA – Natural Resources Conservation Service,” “Assisted by (TSP planner’s name)”; name of applicable conservation district, county, and state; date prepared
2.	Map scale
3.	Information needed to locate the planning area, such as geographic coordinates, public land survey coordinates, etc.
4.	North arrow
5.	Appropriate map symbols and a map symbol legend on the map or as an attachment
Resource Descriptions	CPA	Y/N	DIA	Y/N	N/A
5.	Property-Level Description – If conditions at the stand level warrant a more detailed description due to significant resource concerns or because they affect stand management recommendations, describe these at the stand level.
a.	Property history
b.	Special sites and social considerations
c.	Air, water, and soil protection
d.	Fish, wildlife, and biodiversity
e.	Protected animal and plant species
f.	Forest products
g.	Recreational uses and aesthetic quality
h.	Grazing practices and Agroforestry
i.	Forest health, including invasive plant species
j.	Archeological, cultural, and historic sites
k.	Wildfire risk reduction and prescribed fire
l.	Carbon sequestration
Resource Descriptions, continued	CPA	Y/N	DIA	Y/N	N/A
m.	Forest of Recognized Importance (America Tree Farm standards)
n.	Management of forest resources
6.	Stand-Level Description – Describe past and existing conditions, any resource concerns or limitations associated with the items below. The following should be included for each stand, or, if there is no variability among management units, they may be provided for the tract/property as a whole.
a.	Stand Label
b.	Client objectives
c.	Acres
d.	Forest type
e.	Dominant and codominant tree species
f.	Basal area
g.	Stocking (percent or qualitative)
h.	Description of stand health
i.	Tree growth potential based on soil interpretations or site index
j.	Description of regeneration, if pertinent to recommendations
k.	Diameter distribution by species, in 2-inch diameter class at minimum, if possible. (DBH may be estimated or measured.)
l.	Site indices for major species
m.	Estimate of current stand age
n.	Estimate canopy height for dominant and codominant trees
o.	Adjacent stand or ownership that present opportunities or limitations to management options
p.	Potential for carbon sequestration
q.	Reforestation and afforestation opportunities
r.	Soil descriptions, including relevant soil interpretations.
s.	Physiography, including slope, topography, and aspect
t.	Access to the stand and conditions of roads, trails, landings, and stream crossings, and their condition.
u.	Wildfire risk (surface and crown fires)
V.	Prescribed burning opportunities
w.	Disease, insects, and other pest risks
x.	Fish and wildlife species and habitat elements
y.	Noxious and invasive plant species
z.	Steams, wetlands, ponds, and lakes
aa.	Applied conservation practices required for the system, by NRCS conservation practice name and code, and amount applied.
bb.	Past management, harvesting, natural disturbance events, and land use history.
7.	Identification of Resource Concerns
a.	Documentation of Resource Concerns (RCs)2, using NRCS recognized RC categories for each land use at a minimum.

Prescriptions	CPA	Y/N	DIA	Y/N	N/A
8.	Desired Future Conditions (DFCs) – Provide the following for each stand:
a.	DFC narrative, including species composition and applicable measures such as basal area, stocking, diameter distribution, etc.
b.	Description of regeneration techniques, silvicultural and harvesting systems, and future monitoring that will be used to achieve the DFC.
c.	Alternatives for achieving the DFC and document the effect of each alternative on RCs.
9.	Planned Forestry Conservation Practices3
a.	Recommended forest management activities, including practice implementation, maintenance, and/or monitoring for each forest stand, with a brief description of each.
b.	NRCS practice name and code.
c.	Amount to be applied (in acres, feet, or number).
d.	Schedule for implementation (by month and year), for practices and/or to conduct maintenance/monitoring activities.
e.	Brief description of the planned practice.
f.	Silvicultural prescriptions and necessary specifications for each “preferred alternative” practice scheduled within a five-year timeframe. (Provide site-specific practice installation details that meet the criteria in the “Plan and Specifications” section of the applicable Conservation Practice Standard.
g.	Description of how Forestry Best Management Practices will be applied.
h.	Description of permits needed.
i.	Operation and Maintenance agreements and procedures.
j.	Cost estimate for each practice.
10.	Non-Forestry Practices⁴ – For non-forestry practices needed to meet client objectives, provide the following:
a.	Stand where that practice will be installed.
b.	NRCS practice name and code.
c.	Amount to be applied (in acres, feet, or number)
d.	Schedule for implementation (year)
¹ TSPs must include a statement on the cover sheet of both activities that services provided:
a.	Comply with all applicable Federal, State, Tribal, and local laws and requirements.
b.	Meet applicable program requirements and recommended planned practices are based on NRCS conservation practice standards.
c.	Are consistent with and meet the conservation program goals and objectives for which the program contract was entered into by the client.
d.	Incorporate alternatives that are both cost effective and appropriate to address the resource issues.
2 Resource Concern Information, including appropriate assessment tools for each resource concern, can be found in the National Resource Concern List and Planning Criteria in the VA eFOTG Section III.
3 Include conservation practices that address a resource need as indicated on other documentation. For conservation practices to be eligible for the EQIP funding they must comply with the NRCS-VA Conservation Practice Standards (see VA eFOTG Section IV), address a resource concern, and meet NRCS Planning Criteria.
Note: Not all conservation practices are eligible for funding through NRCS Programs (EQIP, CSP, etc.). For a complete list of eligible conservation practices, visit the specific program pages. However, TSPs are encouraged to include any appropriate conservation practices and activities in the plan to provide technical guidance to clients.
When any of the following practices are scheduled to be applied in a DIA 165, site-specific specifications must be included in the plan package. The DIA may include as appropriate, but is not limited to, the conservation practices listed below:
Practice Name	Code	Practice Name	Code
Access Control	472	Herbaceous Weed Control	315
Alley Cropping	311	Prescribed Burning	338
Brush Management	314	Riparian Forest Buffer	391
Conservation Cover	327	Road/Trail/Landing Closure and Treatment	654
Critical Area Planting	342	Silvopasture	381
Deep Tillage	324	Tree/Shrub Establishment	612
Early Successional Habitat Development	647	Tree/Shrub Site Preparation	490
Firebreak	394	Woody Residue Treatment	384
Forest Stand Improvement	666	Windbreak/Shelterbelt Est. and Ren.	380
Forest Trails and Landings	655

4 Primary NRCS forestry and agroforestry practices, but additional conservation practices may be needed to meet all the client’s objectives. For all other practices, document the planned amount, the field/stands where the practice is to be applied, and the planned month and year of application, if possible. Practices beyond the basic forestry/agroforestry practices may be included in a plan but they will be planned by an appropriately certified TSP, NRCS staff or other professional.
This checklist is consistent with the national NRCS Forest Management Plan Conservation Planning Activity (Code CPA-106 and Forest Management Design and Implementation Activity (Code DIA-165) criteria, October 2021.