EPA Grantee Forms
***Attention: Please note that these forms are still valid despite the "Expires 06/30/2017" displayed in the margins of the forms. These forms are currently under review by the Office of Management and Budget (OMB) under EPA Information Collection Request (ICR) # 0938.21 (OMB # 2030-0020) and are valid while under review. When the ICR renewal is complete the forms will be updated with a new expiration date.
Forms used by grant applicants and recipients are provided below. Forms for fellowships are listed separately.
Forms for Grant Applicants (Pre-Award)
The following forms are used by grant applicants.
|EPA Form 4700‑4||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||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||Key Contacts Form for Multiple Principal Investigators||Additional Key Contacts Form for organizations with multiple principal investigators.|
|EPA Form 6600‑06||Certification Regarding Lobbying||Contains certifications about the use of Federal appropriated funds in connection with lobbying.|
|EPA Form 6600‑09||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||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)(3 pp, 264 K, About 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)(3 pp, 313 K, About PDF)||Budget Information for Non-Construction Programs||Collects budget information for Non-Construction Programs.|
|SF‑424B (OMB PDF)(2 pp, 112 K, About PDF)||Assurances for Non-Construction Programs||Provides assurances for Non-Construction Programs.|
|SF‑424C (OMB PDF)(1 pp, 165 K, About PDF)||Budget Information for Construction Programs||Collects budget Information for Construction Programs.|
|SF‑424D (OMB PDF)(2 pp, 121 K, About PDF)||Assurances for Construction Programs||Provides assurances for Construction Programs.|
|SF‑LLL (OMB PDF)(1 pg, 31 K, About 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||US EPA Payment Request||Used to request payment from EPA for assistance agreements or grants.|
|EPA Form 5700‑52A||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||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||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||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||Outlay Report and Request for Reimbursement for Construction Programs||Used by recipients of construction grants to request reimbursements.|
|SF‑3881 (OMB PDF)(3 pp, 23 K, About 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||Federal Financial Report||Used by recipients to submit reports on their grant's financial progress.|
|SF‑425A||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‑428-A (OMB PDF)||Tangible Personal Property – Annual Report||Used by recipients of Federal financial assistance when required to provide annual inventory listings of Federally-owned property.|
|SF‑428-B (OMB PDF)||Tangible Personal Property – Final Report||Used by recipients when required to provide a final property report for closeout of Federal assistance awards.|
|SF‑428-C (OMB PDF)||Tangible Personal Property – Disposition Request/Report||Used by recipients when required to request disposition instructions or to report disposition of Federally-owned property or acquired equipment under Federal assistance awards at any time other than award closeout (i.e., during the award period or after closeout as long as the Federal government retains an interest in the item).|
|SF‑428S (OMB PDF)||Tangible Personal Property – Supplemental Sheet||Used by recipients to provide detailed individual item information in connection with required reports of tangible personal property under Federal assistance awards.|
|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||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||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||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||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||Completion of Studies Notice||Used to officially terminate the fellowship.|