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Small Business Policy Self-Disclosure Questionnaire

When a small business discovers a potential violation, information on the location of the facility and the nature of the violation need to be included in a letter to EPA within 21 days of discovering the violation to request penalty relief under the Small Business Compliance Policy. Letters disclosing potential violations at facilities in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia or West Virginia, can be faxed to 215-814-2905 or mailed to:

Samantha Phillips Beers, Esq., Director
Office of Enforcement, Compliance 
and Environmental Justice (3EC00)
EPA Mid-Atlantic Region
1650 Arch Street
Philadelphia, PA 19103

EPA may need additional information to determine if the disclosure meets the conditions of the Small Business Compliance Policy (April 11, 2000) for each potential violation disclosed. The following questions are examples of information facilities might be asked to provide. Note that disclosures that do not meet the criteria for complete penalty waivers under the Small Business Compliance Policy might qualify for penalty reductions under other EPA policies.


  1. Name and complete address of the facility where the violation(s) occurred.
  2. The total number of employees across all facilities and operations owned by the company (must be 100 or less for consideration under the policy).
  3. Describe the violation(s) and state the specific regulatory or statutory provision violated to the best of your ability.


  1. Condition 1: Discovery is Voluntary

    a. Explain how the violation was voluntarily discovered (e.g., Used a checklist of questions from a website or publication, received information in an article, attended a workshop, etc.).

    b. Identify the name, title, and employer of each individual who discovered the violation.

  2. Condition 2: Period is Met

    a. State the date on which the violation was initially discovered. (Disclosure letter to EPA must be within 21 calendar days of discovery.)

    b. If the violation was discovered by a person not employed by your company, provide the date and the manner in which your company was made aware of the violation.

    c. If disclosure of the violation to EPA or the state was not within twenty-one (21) calendar days of the date of the initial discovery, or such shorter period as may be provided by law, please explain, in detail, the reasons for the delay.

  3. Condition 3: Violation is Corrected

    Describe in detail all measures that have been taken to remedy the violation and those measures planned to be taken in the future. If you estimate that more than 90 days will be needed to correct the violation, please submit a written schedule to EPA. The violations must be corrected within 180 calendar days after the date they were discovered or within 360 days if pollution prevention measures will be put in place to correct the violations.

  4. Condition 4: When the Policy Does Not Apply

    (If the answer is yes to any of these questions, the disclosure probably 
    does not meet the criteria of the policy.)

    a. Compliance History

  1. Has this facility received a warning letter, notice of violation, or field citation or been subject to a citizen suit or any other enforcement action by a government agency for a violation of the same requirement within the past three years? Yes/No
  2. Did this facility receive a penalty reduction under this policy (or a similar State or Tribal policy) for a violation of the same or similar requirement, within the past 3 years? Yes/No
  3. Has this facility received more than one warning letter, notice of violation, or field citation or been subject to a citizen suit or any other enforcement action by a government agency for any environmental violation within the past five years? Yes/No

b. Was the violation discovered when responding to an information request letter from the government or as a result of a government inspection or field citation. Did the company receive prior notice of commencement of a federal, state or local agency inspection or investigation prior to discovery of the violation? Yes/No

c. Did the violation result in any actual serious harm to human health or the environment? Yes/No Provide a full explanation of how this conclusion was reached.

d. Is the violation one that may present an imminent and substantial endangerment to public health, safety or the environment? Yes/No Provide a full explanation of how this conclusion was reached.

   5.    Certification

The following certification should be signed by an officer or other responsible corporate official and accompany your response.

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information contained in or accompanying this document is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment.

This required submission of information is not subject to the approval requirements of the Paperwork Reduction Act of 1980, 44 U.S.C. Section 3501 et seq.

Additional Information

Mid-Atlantic Office of Enforcement
Compliance and Environmental Justice

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