EPA FORM 6100-2 (DBE Subcontractor Participation Form) 

Disadvantaged Business Enterprise (DBE) Program 

DBE Subcontractor Participation Form 

An EPA Financial Assistance Agreement Recipient must require its prime contractors to provide this form to its 

DBE subcontractors. This form gives a DBE1 subcontractor2 the opportunity to describe work received and/or 

report any concerns regarding the EPA-funded project (e.g., in areas such as termination by prime contractor, late 

payments, etc.). The DBE subcontractor can, as an option, complete and submit this form to the EPA DBE 

Coordinator at any time during the project period of performance. 

Subcontractor Name Project Name

Bid/ Proposal No. Assistance Agreement ID No. (if known) Point of Contact

Address

Telephone No. Email Address

Prime Contractor Name Issuing/Funding Entity:

Contract 

Item 

Number

Description of Work Received from the Prime Contractor Involving 

Construction, Services , Equipment or Supplies

Amount Received 

by Prime 

Contractor

1 A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certifications as 

described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as 

described in 40 CFR 33.202. 

2 Subcontractor 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.

OMB Control No: 2090-0030 

Approval Expires: XX/XX/XX
EPA FORM 6100-2 (DBE Subcontractor Participation Form) 

OMB Control No: 

Approved: 

Approval Expires: 

Disadvantaged Business Enterprise (DBE) Program 

DBE Subcontractor Participation Form 

Please use the space below to report any concerns regarding the above EPA-funded project: 

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The public reporting and recordkeeping burden for this collection of information is estimated to average 1 hour 

per response. 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 through the use of automated 

collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency 

(2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any 

correspondence. Do not send the completed form to this address.

Subcontractor Signature Print Name

Title Date