EPA Grantee Forms
Forms used by grant applicants and recipients are provided below. Forms for fellowships are listed separately.
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Forms for Grant Applicants (Pre-Award)
The following forms are used by grant applicants.
|EPA Form 4700‑4 (PDF) (2 pp, 239K)||Preaward Compliance Review Report for All Applicants and Recipients Requesting Federal Financial Assistance||Collects information that enables EPA to determine whether applicants are developing projects, programs, and activities on a non-discriminatory basis.|
|EPA Form 5700‑54 (PDF) (1 pg, 132K)||Key Contacts Form||Collects contact information for individuals responsible for various aspects of the proposed work, including authorized representative, payee, administrative contact, and investigators.|
|EPA Form 5700‑54‑2 (PDF) (1 pg, 48K)||Key Contacts Form for Multiple Principal Investigators||Additional Key Contacts Form for organizations with multiple principal investigators.|
|EPA Form 6600‑06 (PDF) (1 pg, 431K)||Certification Regarding Lobbying||Contains certifications about the use of Federal appropriated funds in connection with lobbying.|
|EPA Form 6600‑09 (PDF) (4 pp, 182K)||EPA Administrative Capability Questionnaire||Completed by non-profit organizations seeking EPA grant awards of more than $200,000 and under certain special conditions.|
|NCER Form 5 (PDF) (1 pg, 454K)||Current and Pending Support||Collects information to determine whether the principal investigator has available capability to handle the additional workload proposed by EPA under research grants.|
|SF‑424 (OMB PDF)||Application for Federal Assistance||Requires basic information about the applicant (name, address, telephone number, type of applicant, etc.), including a list of sources of proposed funding and a description of the proposed project.|
|SF‑424A (OMB PDF)||Budget Information for Non-Construction Programs||Collects budget information for Non-Construction Programs.|
|SF‑424B (OMB PDF)||Assurances for Non-Construction Programs||Provides assurances for Non-Construction Programs.|
|SF‑424C (OMB PDF)||Budget Information for Construction Programs||Collects budget Information for Construction Programs.|
|SF‑424D (OMB PDF)||Assurances for Construction Programs||Provides assurances for Construction Programs.|
|SF‑LLL (OMB PDF)||Disclosure of Lobbying Activities||Used by applicants to disclose lobbying activities that have been secured to influence the outcome of a Federal action.|
Forms for Grant Recipients (Post-Award)
The following forms are used by grant recipients.
|EPA Form 190‑F‑04‑001 (PDF) (1 pg, 148K)||US EPA Payment Request||Used to request payment from EPA for assistance agreements or grants.|
|EPA Form 5700‑52A (PDF) (5 pp, 310K)||MBE/WBE Utilization Under Federal Grants||Completed by recipients of Federal grants, cooperative agreements, or other Federal financial assistance which involve procurement of supplies, equipment, construction or services to accomplish Federal assistance programs.|
|EPA Form 5700‑53 (PDF) (1 pg, 463K)||Lobbying and Litigation Certificate||Completed at project completion to certify that funds have not been used to engage in the lobbying of the Federal Government or in litigation against the United States.|
|EPA Form 6600‑08 (PDF) (2 pp, 47K)||Lobbying Cost Certificate for Indirect Costs/Certificate of Indirect Costs for State and Local Governments||Completed by non-profit grant recipients and contains the certification required by OMB Circular A-122.|
|SF‑270 (OMB PDF)||Request for Advance or Reimbursement||Used by recipients to request advances or reimbursement on all non-construction programs when the advance payment or reimbursement methods are used.|
|SF‑271 (OMB PDF)||Outlay Report and Request for Reimbursement for Construction Programs||Used by recipients of construction grants to request reimbursements.|
|SF‑3881 (OMB PDF)||ACH Vendor/Miscellaneous Payment Enrollment Form||Completed by grant recipients to enable the U.S. Treasury Department to transmit payment data, by electronic means, to vendor's financial institution.|
|SF‑425 (OMB PDF, Excel, Instructions)||Federal Financial Report||Used by recipients to submit reports on their grant's financial progress.|
|SF‑425A (OMB PDF, Excel, Instructions)||Federal Financial Report Attachment||Used by recipients for reporting on cash management activity for multiple grants.|
|SF‑428 (OMB PDF)||Tangible Personal Property||Used by recipients to report on tangible personal property (equipment and supplies) when required by a Federal financial assistance award.|
|SF‑429 (OMB PDF)||Real Property Status Report||Used by recipients of Federal financial assistance to report real property status or to request agency instructions on real property that was/will be provided as Government Furnished Property (GFP) or acquired (i.e. purchased or constructed) in whole or in part under a Federal financial assistance award.|
|SF‑SAC||Data Collection Form for Single Audits||Requires non-federal entities that expend $500,000 or more in a year in federal awards to conduct an audit in accordance with OMB Circular A-133, “Audits of States, Local Governments, and Non-Profit Organizations.”|
Forms for Fellowships
The following forms are used to apply for a fellowship.
|EPA Form 5770‑2 (PDF) (4 pp, 279K)||Fellowship Application||Basic application form for individuals seeking fellowships and requires information on the applicant's educational and work experience background.|
|EPA Form 5770‑3 (PDF) (1 pg, 163K)||Fellowship Facilities and Commitment Statement||Requires information about the institution that will sponsor the fellowship applicant, the sponsor's summarized plans for the applicant's training, and the institution's commitment to provide that training.|
|EPA Form 5770‑5 (PDF) (1 pg, 182K)||Agency Fellowship Certification||Used by applicants who are current or prospective employees of a regional, State, or local environmental pollution control or regulatory agency.|
The following forms are used after a fellowship has been awarded.
|EPA Form 190‑F‑05‑001 (PDF) (2 pp, 233K)||Fellowship Stipend Payment Enrollment Form||Completed by fellowship recipients to enable the Treasury Department to transmit payment data, by electronic means, to vendor's financial institution.|
|EPA Form 5770‑9 (PDF) (1 pg, 288K)||Completion of Studies Notice||Used to officially terminate the fellowship.|