In order to help businesses and the general public understand how the Environmental Protection Agency works with companies, the EPA has put together a four-part series of articles explaining the different ways it can work with organizations. The first article in this series will focus on the EPA's self-initiated compliance program. This program helps companies come into compliance with environmental regulations without needing formal enforcement action from the EPA. The EPA Form 6100-4 is a voluntary disclosure form that businesses can use to report environmental violations. Companies that submit this form may be eligible for reduced penalties or other incentives. In this article, we'll explain what the form is and how to complete it. We'll also discuss some of the benefits of using it and outline some of the risks associated with not disclosing environmental violations.
| Question | Answer |
|---|---|
| Form Name | Epa Form 6100 4 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 6100 4 form, dbe subcontractor utilization form, epa 6100 4, dbe form |
Environmental Protection Agency
OMB Control No: _________
Approved: _________
Approval Expires: _________
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Disadvantaged Business Enterprise Program |
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DBE Subcontractor Utilization Form |
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BID/PROPOSAL NO. |
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PROJECT NAME |
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NAME OF PRIME BIDDER/PROPOSER |
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ADDRESS |
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TELEPHONE NO. |
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FAX NO. |
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The following subcontractors1 will be used on this project: |
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COMPANY NAME, ADDRESS, PHONE |
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TYPE OF WORK TO BE |
ESTIMATE |
CURRENTLY |
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NUMBER, AND |
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PERFORMED |
D DOLLAR |
CERTIFIED |
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AMOUNT |
AS AN MBE |
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OR WBE? |
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I certify under penalty of perjury that the forgoing statements are true and correct. In the event of a |
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replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 |
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Section 33.302(c). |
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Signature Of Prime Contractor |
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Date |
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Print Name |
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Title |
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1Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance.
EPA FORM
Environmental Protection Agency
OMB Control No: _________
Approved: _________
Approval Expires: _________
Disadvantaged Business Enterprise Program
DBE Subcontractor Utilization Form
The public reporting and recordkeeping burden for this collection of information is estimated to average fifteen (15) minutes. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed EPA DBE Subcontractor Utilization Form to this address.
EPA FORM