+-----------------------------------------------------------+----------+
| United States Environmental Protection Agency             |          |
|                                                           |          |
| Washington, DC 20460                                      |          |
|                                                           |          |
| **Preaward Compliance Review Report for**                 |          |
|                                                           |          |
| **All Applicants and Recipients Requesting EPA Financial  |          |
| Assistance**                                              |          |
|                                                           |          |
| [**Note**: Read instructions on other side before         |          |
| completing form.]{.underline}                             |          |
+-----------------------------------------------------------+----------+
| I.  Applicant/Recipient (Name, Address, State, Zip Code). | > DUNS   |
|                                                           | > No.    |
+-----------------------------------------------------------+----------+
| II. Is the applicant currently receiving EPA assistance?  |          |
+-----------------------------------------------------------+----------+
| III. List all civil rights lawsuits and administrative    |          |
|      complaints pending against the applicant/recipient   |          |
|      that allege discrimination based on race, color,     |          |
|      national origin, sex, age, or disability. (Do not    |          |
|      include employment complaints not covered by 40      |          |
|      C.F.R. Parts 5 and 7. See instructions on reverse    |          |
|      side.)                                               |          |
+-----------------------------------------------------------+----------+
| IV. List all civil rights lawsuits and administrative     |          |
|     complaints decided against the applicant/recipient    |          |
|     within the last year that allege discrimination based |          |
|     on race, color, national origin, sex, age, or         |          |
|     disability and enclose a copy of all decisions.       |          |
|     Please describe all corrective action taken. (Do not  |          |
|     include employment complaints not covered by 40       |          |
|     C.F.R. Parts 5 and 7. See instructions on reverse     |          |
|     side.)                                                |          |
+-----------------------------------------------------------+----------+
| V.  List all civil rights compliance reviews of the       |          |
|     applicant/recipient conducted by any agency within    |          |
|     the last two years and enclose a copy of the review   |          |
|     and any decisions, orders, or agreements based on the |          |
|     review. Please describe any corrective action taken.  |          |
|     (40 C.F.R. § 7.80(c)(3))                              |          |
+-----------------------------------------------------------+----------+
| VI. Is the applicant requesting EPA assistance for new    |          |
|     construction? If no, proceed to VII; if yes,          |          |
|     answer (a) and/or (b) below.                          |          |
|                                                           |          |
| > a\. If the grant is for new construction, will all new  |          |
| > facilities or alterations to existing facilities be     |          |
| > designed and constructed to be readily accessible to    |          |
| > and usable by persons with disabilities? If yes,        |          |
| > proceed to VII; if no, proceed to VI(b).                |          |
| >                                                         |          |
| > b\. If the grant is for new construction and the new    |          |
| > facilities or alterations to existing facilities will   |          |
| > not be readily accessible to and usable by persons with |          |
| > disabilities, explain how a regulatory exception (40    |          |
| > C.F.R. § 7.70) applies.                                 |          |
+-----------------------------------------------------------+----------+
| > VII.\* Does the applicant/recipient provide initial and |          |
| > continuing notice that it does not discriminate on the  |          |
| > basis of race, color, national origin, sex, age, or     |          |
| > disability in its programs or activities? (40 C.F.R. §  |          |
| > 5.140 and § 7.95)                                       |          |
|                                                           |          |
| a.  Do the methods of notice accommodate those with       |          |
|     impaired vision or hearing?                           |          |
|                                                           |          |
| b.  Is the notice posted in a prominent place in the      |          |
|     applicant's offices or facilities or, for education   |          |
|     programs and activities, in appropriate periodicals   |          |
|     and other written communications?                     |          |
|                                                           |          |
| c.  Does the notice identify a designated civil rights    |          |
|     coordinator?                                          |          |
+-----------------------------------------------------------+----------+
| > VIII.\* Does the applicant/recipient maintain           |          |
| > demographic data on the race, color, national origin,   |          |
| > sex, age, or handicap of the population it serves? (40  |          |
| > C.F.R. § 7.85(a))                                       |          |
+-----------------------------------------------------------+----------+
| > IX.\* Does the applicant/recipient have a               |          |
| > policy/procedure for providing access to services for   |          |
| > persons with limited English proficiency?               |          |
| >                                                         |          |
| > (40 C.F.R. Part 7, E.O. 13166)                          |          |
+-----------------------------------------------------------+----------+
| > X.\* If the applicant/recipient is an education program |          |
| > or activity, or has 15 or more employees, has it        |          |
| > designated an employee to coordinate its compliance     |          |
| > with 40 C.F.R. Parts 5 and 7? Provide the name, title,  |          |
| > position, mailing address, e-mail address, fax number,  |          |
| > and telephone number of the designated coordinator.     |          |
+-----------------------------------------------------------+----------+
| > XI\* If the applicant/recipient is an education program |          |
| > or activity, or has 15 or more employees, has it        |          |
| > adopted grievance procedures that assure the prompt and |          |
| > fair resolution of complaints that allege a violation   |          |
| > of 40 C.F.R. Parts 5 and 7? Provide a legal citation or |          |
| > Internet address for, or a copy of, the procedures.     |          |
+-----------------------------------------------------------+----------+

+----------------------------+---------------------------+-------------+
| > **For the                |                           |             |
| > Applicant/Recipient**    |                           |             |
| >                          |                           |             |
| > I certify that the       |                           |             |
| > statements I have made   |                           |             |
| > on this form and all     |                           |             |
| > attachments thereto are  |                           |             |
| > true, accurate and       |                           |             |
| > complete. I acknowledge  |                           |             |
| > that any knowingly false |                           |             |
| > or misleading statement  |                           |             |
| > may be punishable by     |                           |             |
| > fine or imprisonment or  |                           |             |
| > both under applicable    |                           |             |
| > law. I assure that I     |                           |             |
| > will fully comply with   |                           |             |
| > all applicable civil     |                           |             |
| > rights statutes and EPA  |                           |             |
| > regulations.             |                           |             |
+----------------------------+---------------------------+-------------+
| > A. Signature of          | > B. Title of Authorized  | > C. Date   |
| > Authorized Official      | > Official                |             |
+----------------------------+---------------------------+-------------+

+----------------------------+---------------------------+-------------+
| > **For the U.S.           |                           |             |
| > Environmental Protection |                           |             |
| > Agency**                 |                           |             |
| >                          |                           |             |
| > I have reviewed the      |                           |             |
| > information provided by  |                           |             |
| > the applicant/recipient  |                           |             |
| > and hereby certify that  |                           |             |
| > the applicant/recipient  |                           |             |
| > has submitted all        |                           |             |
| > preaward compliance      |                           |             |
| > information required by  |                           |             |
| > 40 C.F.R. Parts 5 and 7; |                           |             |
| > that based on the        |                           |             |
| > information submitted,   |                           |             |
| > this application         |                           |             |
| > satisfies the preaward   |                           |             |
| > provisions of 40 C.F.R.  |                           |             |
| > Parts 5 and 7; and that  |                           |             |
| > the applicant has given  |                           |             |
| > assurance that it will   |                           |             |
| > fully comply with all    |                           |             |
| > applicable civil rights  |                           |             |
| > statutes and EPA         |                           |             |
| > regulations.             |                           |             |
+----------------------------+---------------------------+-------------+
| A.  Signature of           | > B. Title of Authorized  | > C. Date   |
|     Authorized EPA         | > EPA Official            |             |
|     Official               |                           |             |
|                            |                           |             |
| > See \*\* note on reverse |                           |             |
| > side.                    |                           |             |
+----------------------------+---------------------------+-------------+

> EPA Form 4700-4 (Rev. 03/2008). Previous editions are obsolete.

+---------------------------------+---+---------------------------------+
| > **Instructions for EPA FORM   |   | > **Items**                     |
| > 4700-4 (Rev. 03/2008)**       |   | >                               |
| >                               |   | > "Applicant" means any entity  |
| > **General**                   |   | > that files an application or  |
| >                               |   | > unsolicited proposal or       |
| > Recipients of Federal         |   | > otherwise requests EPA        |
| > financial assistance from the |   | > assistance. 40 C.F.R. §§      |
| > U.S. Environmental Protection |   | > 5.105, 7.25.                  |
| > Agency must comply with the   |   | >                               |
| > following statutes and        |   | > "Recipient" means any entity, |
| > regulations.                  |   | > other than applicant, which   |
| >                               |   | > will actually receive EPA     |
| > [Title VI of the Civil Rights |   | > assistance. 40 C.F.R. §§      |
| > Acts of 1964]{.underline}     |   | > 5.105, 7.25.                  |
| > provides that no person in    |   | >                               |
| > the United States shall, on   |   | > "Civil rights lawsuits and    |
| > the grounds of race, color,   |   | > administrative complaints"    |
| > or national origin, be        |   | > means any lawsuit or          |
| > excluded from participation   |   | > administrative complaint      |
| > in, be denied the benefits    |   | > alleging discrimination on    |
| > of, or be subjected to        |   | > the basis of race, color,     |
| > discrimination under any      |   | > national origin, sex, age, or |
| > program or activity receiving |   | > disability pending or decided |
| > Federal financial assistance. |   | > against the applicant and/or  |
| > The Act goes on to explain    |   | > entity which actually         |
| > that the statute shall not be |   | > benefits from the grant, but  |
| > construed to authorize action |   | > excluding employment          |
| > with respect to any           |   | > complaints not covered by 40  |
| > employment practice of any    |   | > C.F.R. Parts 5 and 7. For     |
| > employer, employment agency,  |   | > example, if a city is the     |
| > or labor organization (except |   | > named applicant but the grant |
| > where the primary objective   |   | > will actually benefit the     |
| > of the Federal financial      |   | > Department of Sewage, civil   |
| > assistance is to provide      |   | > rights lawsuits involving     |
| > employment).                  |   | > both the city and the         |
| >                               |   | > Department of Sewage should   |
| > [Section 13 of the 1972       |   | > be listed.                    |
| > Amendments to the Federal     |   | >                               |
| > Water Pollution Control       |   | > "Civil rights compliance      |
| > Act]{.underline} provides     |   | > review" means any review      |
| > that no person in the United  |   | > assessing the applicant's     |
| > States shall on the ground of |   | > and/or recipient's compliance |
| > sex, be excluded from         |   | > with laws prohibiting         |
| > participation in, be denied   |   | > discrimination on the basis   |
| > the benefits of, or be        |   | > of race, color, national      |
| > subjected to discrimination   |   | > origin, sex, age, or          |
| > under the Federal Water       |   | > disability.                   |
| > Pollution Control Act, as     |   | >                               |
| > amended. Employment           |   | > Submit this form with the     |
| > discrimination on the basis   |   | > original and required copies  |
| > of sex is prohibited in all   |   | > of applications, requests for |
| > such programs or activities.  |   | > extensions, requests for      |
| >                               |   | > increase of funds, etc.       |
| > [Section 504 of the           |   | > Updates of information are    |
| > Rehabilitation Act of         |   | > all that are required after   |
| > 1973]{.underline} provides    |   | > the initial application       |
| > that no otherwise qualified   |   | > submission.                   |
| > individual with a disability  |   | >                               |
| > in the United States shall    |   | > If any item is not relevant   |
| > solely by reason of           |   | > to the project for which      |
| > disability be excluded from   |   | > assistance is requested,      |
| > participation in, be denied   |   | > write "NA" for "Not           |
| > the benefits of, or be        |   | > Applicable."                  |
| > subjected to discrimination   |   | >                               |
| > under any program or activity |   | > In the event applicant is     |
| > receiving Federal financial   |   | > uncertain about how to answer |
| > assistance. Employment        |   | > any questions, EPA program    |
| > discrimination on the basis   |   | > officials should be contacted |
| > of disability is prohibited   |   | > for clarification.            |
| > in all such programs or       |   | >                               |
| > activities.                   |   | > \* Questions VII -- XI are    |
| >                               |   | > for informational use only    |
| > [The Age Discrimination Act   |   | > and will not affect an        |
| > of 1975]{.underline} provides |   | > applicant's grant status.     |
| > that no person on the basis   |   | > However, applicants should    |
| > of age shall be excluded from |   | > answer all questions on this  |
| > participation under any       |   | > form. (40 C.F.R. Parts 5 and  |
| > program or activity receiving |   | > 7).                           |
| > Federal financial assistance. |   | >                               |
| > Employment discrimination is  |   | > \*\* Note: Signature appears  |
| > not covered. Age              |   | > in the Approval Section of    |
| > discrimination in employment  |   | > the EPA Comprehensive         |
| > is prohibited by the Age      |   | > Administrative Review For     |
| > Discrimination in Employment  |   | > Grants/Cooperative Agreements |
| > Act administered by the Equal |   | > & Continuation/Supplemental   |
| > Employment Opportunity        |   | > Awards form.                  |
| > Commission.                   |   | >                               |
| >                               |   | > Approval indicates, in the    |
| > [Title IX of the Education    |   | > reviewer's opinion, questions |
| > Amendments of                 |   | > I -- VI of Form 4700-4 comply |
| > 1972]{.underline} provides    |   | > with the preaward             |
| > that no person in the United  |   | > administrative requirements   |
| > States on the basis of sex    |   | > for EPA assistance.           |
| > shall be excluded from        |   | >                               |
| > participation in, be denied   |   | > **"Burden Disclosure          |
| > the benefits of, or be        |   | > Statement"**                  |
| > subjected to discrimination   |   | >                               |
| > under any education program   |   | > EPA estimates public          |
| > or activity receiving Federal |   | > reporting burden for the      |
| > financial assistance.         |   | > preparation of this form to   |
| > Employment discrimination on  |   | > average 30 minutes per        |
| > the basis of sex is           |   | > response. This estimate       |
| > prohibited in all such        |   | > includes the time for         |
| > education programs or         |   | > reviewing instructions,       |
| > activities. Note: an          |   | > gathering and maintaining the |
| > education program or activity |   | > data needed and completing    |
| > is not limited to only those  |   | > and reviewing the form. Send  |
| > conducted by a formal         |   | > comments regarding the burden |
| > institution.                  |   | > estimate, including           |
| >                               |   | > suggestions for reducing this |
| > [40 C.F.R. Part               |   | > burden, to U.S. EPA, Attn:    |
| > 5]{.underline} implements     |   | > Collection Strategies         |
| > Title IX of the Education     |   | > Division (MC 2822T), Office   |
| > Amendments of 1972.           |   | > of Information Collection,    |
| >                               |   | > 1200 Pennsylvania Ave., NW,   |
| > [40 C.F.R. Part               |   | > Washington, D.C. 20460; and   |
| > 7]{.underline} implements     |   | > to the Office of Information  |
| > Title VI of the Civil Rights  |   | > and Regulatory Affairs,       |
| > Act of 1964, Section 13 of    |   | > Office of Management and      |
| > the 1972 Amendments to the    |   | > Budget, Washington, D.C.      |
| > Federal Water Pollution       |   | > 20503.                        |
| > Control Act, and Section 504  |   | >                               |
| > of The Rehabilitation Act of  |   | > The information on this form  |
| > 1973.                         |   | > is required to enable the     |
| >                               |   | > U.S. Environmental Protection |
| > [The Executive Order 13166    |   | > Agency to determine whether   |
| > (E.O. 13166)]{.underline}     |   | > applicants and prospective    |
| > entitled; \"Improving Access  |   | > recipients are developing     |
| > to Services for Persons with  |   | > projects, programs and        |
| > Limited English Proficiency\" |   | > activities on a               |
| > requires Federal agencies     |   | > nondiscriminatory basis as    |
| > work to ensure that           |   | > required by the above         |
| > recipients of Federal         |   | > statutes and regulations.     |
| > financial assistance provide  |   |                                 |
| > meaningful access to their    |   |                                 |
| > LEP applicants and            |   |                                 |
| > beneficiaries.                |   |                                 |
+---------------------------------+---+---------------------------------+