Operating Permits

Forms for Part 71 Federal Operating Permits

These forms are used to prepare the initial part 71 permit application, and subsequently, to submit other required information. Please check with 

the appropriate EPA Regional Office for guidance on the proper forms and how to obtain them. The forms on this page may be downloaded and 

printed but are not suitable for on-line data entry or electronic submittal. Each form below contains detailed instructions; the instruction manual 

contains general instructions that are relevant to all forms.

Recent Changes to Part 71 Forms:

• On June 25, 2012, we revised all forms to update the expiration date of the information collection requests(ICRs) for the forms.

On June 10 , 2011, we revised the Fee Filing form and instructions to clarify certain location and contact information related to fee 

payment.

•

• On October 6, 2010, we revised all forms to update the expiration date of the information collection requests (ICRs) for the forms.

On March 5, 2009, we revised the Fee Calculation Worksheet (FEE) to clarify the instructions, particularly with respect to reconciliation 

procedures. 

•

On March 6, 2008, we revised the Fee Calculation Worksheet (FEE) to correct the method for calculating actual emissions. This 

problem may have lead to incorrect fee calculation for a small number of large sources after October 11, 2007.

•

On October 31, 2007, we revised the instructions for the Fee Filing form to update the addresses for fee payment (the lockbox account 

addresses). The new addresses are effective immediately. 

•

On October 2, 2007, we revised all forms to some extent. Primarily, we simplified the instructions for all forms, updated EPA contact 

information, updated the OMB approval expiration date, and added official EPA form numbers. 

•

On February 22, 2004, we revised the Annual Compliance Certification form and the Instruction Manual to reflect policy decisions 

concerning monitoring and the data used for compliance certifications. 

•

Forms

[Please note: all Microsoft Word (DOC) files should be downloaded prior to viewing. PDF files require the Adobe Acrobat Reader for reading or 

printing. For more information and how to obtain the Acrobat Reader, see the EPA's About Adobe Acrobat page.]

• Instruction Manual for Part 71 Forms | DOC (4pp, 67k) | PDF (4pp, 29k)

• Initial Application Forms 

◦ General Information and Summary (GIS) | DOC (6pp, 59k) | PDF (6pp, 30k)

◦ Emission Unit Description for Combustion Sources (EUD1) | DOC (4pp, 45k) | PDF (4pp, 25k)

◦ Emission Unit Description for VOC emitting Sources (EUD2) | DOC (3pp, 48k) | PDF (3pp, 24k)

◦ Emission Unit Description for Process Sources (EUD3) | DOC (3pp, 37k) | PDF (3pp, 23k)

◦ Insignificant Activities (IE) | DOC (2pp, 44k) | PDF (2pp, 27k)

◦ Emission Calculations (EMISS) | DOC (3pp, 46k) | PDF (3pp, 26k)

◦ Potential to Emit Summary (PTE) | DOC (2pp, 47k) | PDF (2pp, 23k)

◦ Fee Calculation Worksheet (FEE) | DOC (10pp, 158k) | PDF (10pp, 56k)

◦ Fee Filing (FF) | DOC (2pp, 41k) | PDF (2pp, 25k)

◦ Initial Compliance Plan and Compliance Certification (I-COMP) | DOC (5pp, 64k) | PDF (5pp, 29k)

◦ Certification of Truth, Accuracy, and Completeness (CTAC) | DOC (2pp, 34k) | PDF (2pp, 21k)

• Forms Used After Permit Issuance

◦ Prompt Deviation Report (PDR) | DOC (4pp, 40k) | PDF (4pp, 29k)

◦ 6-Month Monitoring Report (SIXMON) | DOC (7pp, 57k) | PDF (7pp, 30k)

◦ Fee Calculation Worksheet (FEE) | DOC (10pp, 158k) | PDF (10pp, 56k)

Application Forms for Part 71 Operating Permits | Operating Permits | US EPA Page 1 of 2

file://C:\Program Files (x86)\Documentum\CTS\docbases\ProDocbase\config\temp_sessions\3581554333878703... 3/27/2013
◦ Fee Filing (FF) | DOC (2pp, 41k) | PDF (2pp, 25k)

◦ Annual Compliance Certification (A-COMP) | DOC (7pp, 52k) | PDF (7pp, 29k)

◦ Certification of Truth, Accuracy, and Completeness (CTAC) | DOC (2pp, 34k) | PDF (2pp, 21k)

For current information, or more details, contact Jeff Herring at (919) 541-3195 or by e-mail at herring.jeff@epa.gov. 

Application Forms for Part 71 Operating Permits | Operating Permits | US EPA Page 2 of 2

file://C:\Program Files (x86)\Documentum\CTS\docbases\ProDocbase\config\temp_sessions\3581554333878703... 3/27/2013