Worksheet Description

Instruction Guide

General information about the CBM Screener Guide including the purpose of 

the data collection, duty to respond within 30 days, filing for an extension, 

claiming business information to be confidential, contacting us, and returning 

the screener.

Cover Page

Brief instructions for the screener and helpline contact information. Also 

includes space to complete the address label and enter screener ID number.

Item A-E User 

Guide

Instructions for each worksheet and column on the use of the Item A-C and the 

Item D-E electronic spreadsheets. 

Item A-C Questions on the establishment name, establishment contact information, and 

operating status in 2008.

Item D-E Questions on business size and financial data availability and the number of 

coalbed methane projects in 2008.

Item F User Guide Instructions for each worksheet and column on the use of the Item F electronic 

spreadsheets. 

Item F Project 

Information

Includes questions on the name of the project, the number of wells, the 

combined gas production, and management of the produced water.

Item F Contact 

Information

Includes questions on where to send a second questionnaire if the project is 

selected, the contact person name, employer, street address, city, state, zip, 

phone, and email.

Remarks Spaces to clarify responses if appropriate

Instructions for Completing the Screener. Please read all instructions.

1. Select from the Excel menu Tools --> Macro --> Security

Part I - EPA's Purpose for Collecting the Data

The U.S. Environmental Protection Agency (EPA) is conducting this screener as part of its annual review of existing effluent guidelines, which is required by the Clean Water Act (CWA) sections 

301(d) and 304(b). As part of this review, EPA is collecting information about coalbed methane (CBM) extraction operations as part of its effort to determine whether to initiate a rulemaking to 

potentially revise the effluent guidelines for the Oil and Gas Extraction Point Source Category (40 CFR 435) to include limits for pollutants discharged in CBM produced water. The screener 

collects only information that EPA needs to select a representative sample of the industry for the detailed questionnaire. Some establishments will receive more than one survey. These 

establishments, according to our records, operate in more than one basin and/or state. These establishments are required to fill out a survey for each of the basins and/or states.To ensure that 

the detailed questionnaire sample:

• Contains only CBM operations, the screener verifies that the establishment operates CBM wells. For the purpose of the screener, EPA is defining CBM wells to be wells that produced or will be 

producing at least some of their gas from coal bearing strata. They include wells that commingle CBM with conventional gas, wells that produce water for the purpose of dewatering prior to 

production, wells that are temporarily shut in, or otherwise awaiting production.

• Includes small businesses, the screener asks whether the parent company is "small" according to the Small Business Administration.

• Is contacted when most projects will have complete financial data for 2008, the screener asks for the date when either the audited or unaudited data will be available.

• Identifies basins and specific projects using names familiar to the operator, the screener requests the operator's name or identifier for the basin and project.

• Includes projects of various sizes, the screener asks for total gas production, number of wells, and whether the project was owned by the same establishment for the entire year.

• Includes projects that discharge into rivers and streams, the screener requests information about produced water discharge practices 

Part II - Duty to Respond Within 30 Days

3. Close the survey and then open it again

Spreadsheet Navigation: This electronic survey uses macros buttons to move from one worksheet to another. It is important to note that these arrows only take you to another worksheet. Within 

that worksheet you will have to move to the appropriate cell that corresponds to the question you are referring to. If you are having difficulty enabling macros on your computer, you can use the 

labeled tabs at the bottom of the survey to move from one worksheet to another. Within a worksheet, you can move to the neighboring cell to the right by hitting the Tab key. Some cells in this 

survey are locked and therefore cannot be changed or manipulated by the user.

EPA is conducting this data collection under the authority of Section 308 of the Clean Water Act (Federal Water Pollution Control Act, 33 U.S.C. Section 1318). You must respond to this 

questionnaire within 30 days of receiving it. Failure to respond, late filing, or failure to comply with the instructions may result in criminal fines, civil penalties, and other sanctions, as provided by 

law.

The public reporting and recordkeeping burden for this collection of information is estimated to average 5 hours per response. Burden means the total time, effort, or financial resources expended 

by persons and the Federal Agency to generate, maintain, retain, or disclose or provide information. 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 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.

To comment 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, EPA has established a public docket for this ICR under Docket ID No. EPA-HQ-OW-2006-0771, which is available for public viewing at the Water Docket in the EPA 

Docket Center (EPA/DC), EPA West, Room B102, 1301 Constitution Ave., NW, Washington, DC 20004. The EPA Docket Center Public Reading Room is open from 8:30 a.m. to 4:30 p.m., Monday 

through Friday, excluding legal holidays. The telephone number for the Reading Room is (202) 566-1744, and the telephone number for the Water Docket is (202) 566-2426. An electronic version of 

the public docket is available through the federal data management system (FDMS) at http://www.regulations.gov. Use FDMS to submit or view public comments, access the index listing available 

electronically. Also, you can send comments to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk 

2008 Coalbed Methane Industry Screener

Part I- EPA's Purpose for Collecting the Data

Part II- Duty to Respond Within 30 Days

Part III- Filing for An Extension

NOTE: This electronic survey uses macros and they must be enabled to maximize functionality

Upon opening the file, click the link “Click to go to Cover Page.” If a macro error box appears, you must do the following:

4. The "Security Warning" box should now appear and click "Enable Macros"

How to enable macros in Microsoft Excel 2007:

Pat IV- Claiming Business Information to be Confidential

Part V- Contacting Us

Part VI- Returning the Screener

How to enable macros in Microsoft Excel 2003:

***Each electronic survey has enough spaces for 25 projects. If you have more than 25 projects please download and submit an additional electronic survey*** 

4. A message will prompt you to save the survey.

5. Save and then reopen the survey. 

If you open the electronic survey and the "Security Warning" box does not appear then you must change the security setting by doing the following:

3. Close the survey.

2. Select radio button beside “Enable all macros” and click “Ok.”

1. Select “Office” button --> “Excel Options” button (bottom of menu) --> “Trust Center” link in left column --> 

“Trust Center Settings” button --> “Macro Settings” link in left column

2. In the Security box select "Medium Security" and press Ok

Click to go to Cover 

Page
Frequently asked questions regarding the screener can be found on the EPA Website at http://www.epa.gov/guide/cbm

Save the electronic screener to a CD or disc and mail the survey 

to:

U.S. Environmental Protection Agency

CBM Industry Screener

c/o PG Environmental, LLC

570 Herndon Parkway

Suite 500

Herndon, VA 20170

Extension requests will be evaluated on a case-by-case basis. Submittal of an extension request to EPA does not alter the due date of your questionnaire unless EPA agrees to the extension and 

establishes a new date.

Mr. Carey Johnston Mr. Carey Johnston

To return the screener upon completion, please:

CBM Helpline: 1-800-764-4414

Regulations governing the confidentiality of business information are contained in the Code of Federal Regulations (CFR) at Title 40 Part 2, Subpart B. You may assert a business confidentiality 

claim covering part or all of the information you submit, other than effluent data and information or data that is otherwise publicly available, as described in 40 CFR 2.203(b):

1200 Pennsylvania Avenue, N.W.

Part VI - Returning the Screener

Room 6231G, EPA West

EPA has contracted with two private firms, PG Environmental and ERG, to operate a telephone and electronic mail helpline to assist respondents with any questions or concerns about the 

screener. You will receive a reply within 1 business day of contacting the helpline:

Part IV - Claiming Business Information to be Confidential

Washington, DC 20004

" (b) Method and time of asserting business confidentiality claim. A business which is submitting information to EPA may assert a business confidentiality claim covering the 

information by placing on (or attaching to) the information, at the time it is submitted to EPA, a cover sheet, stamped or typed legend, or other suitable form of notice complying 

language such as 'trade secret,' 'proprietary,' or 'company confidential.' Allegedly confidential portions of otherwise non-confidential documents should be clearly identified by 

the business, an may be submitted separately to facilitate identification and handling by EPA. If the business desires confidential treatment only until a certain date or until the 

occurrence of a certain event, the notice should so state."

You may claim as confidential all information included in the response to a question by stating so in the Remarks section of the Screener. Note that you may be required to justify any claim of 

confidentiality at a later time. Note also that facility effluent data are not eligible for confidential treatment, pursuant to Section 308(b) of the CWA, and thus will be treated as non-confidential even 

if the CBI box is checked. In addition, information that is publicly-available should not be claimed confidential. Note also that information claimed confidential cannot be accessed, verified, or 

used by the industry to evaluate data and analyses supporting the results of the CBM study.

Information covered by a claim of confidentiality will be disclosed by EPA only to the extent of, and by means of, the procedures set forth in 40 CFR Part 2, Subpart B. In general, submitted 

information protected by a business confidentiality claim may be disclosed to other employees, officers, or authorized representatives of the United States concerned with implementing the CWA. 

Exemption 4 of the Freedom of Information Act (FOIA) protects from disclosure "trade secrets and commercial or financial information obtained from a person and privileged or confidential." See 

5 U.S.C. 552(b)(4).

If you wish to request an extension, you must do so in writing within 14 days of receipt of this questionnaire. Written requests may be e-mailed to Mr. Carey Johnston at johnston.carey@epa.gov 

with "CBM Survey Extension Request" in the e-mail subject line, or may be mailed to:

United States Postal Service 1 or 2-Day Delivery (e.g. FedEx)

U.S. EPA, Office of Water

Mail Code: 4303T

Internet Electronic Mailing Address: cbmscreener@pgenv.com

U.S. EPA, Office of Water

electronically. Also, you can send comments to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk 

Officer for EPA. Please include EPA Docket ID No. EPA-HQ-OW-2006-0771 and OMB control number (2040-0279) in any correspondence.

Part III - Filing for an Extension

1301 Constitution Avenue, N.W.

Washington, DC 20460

Information covered by a claim of confidentiality will be made available to EPA contractors and subcontractors under EPA Contract Numbers No. 68-C02-095 (Eastern Research Group, Inc.), EP-C07-029 (PG Environmental, LLC, Eastern Research Group, Inc.), EP-C-05-030 (Battelle), and GS-10F-0209P (Advanced Resources International, Inc.) to enable the contractors to perform the work 

required by their contracts with EPA. All EPA contracts provide that contractor employees use the information only for the purpose of performing the work required by their contracts and will not 

disclose any CBI to anyone other than EPA without prior written approval from each affected business or from EPA's legal office. EPA has approved written procedures for each contractor on how 

they will gather, safeguard, and secure CBI. Any comments you may wish to make on this issue must be submitted in writing along with your completed survey.

If no business confidentiality claim accompanies the information when it is received by EPA, EPA may make the information available to the public without further notice.

Part V - Contacting Us
Screener ID: 

OMB-2040-0279

(Expires February 29, 2012)

Due Date: Within 30 days of receipt

Click to Return to 

Instruction Guide

• Please type in the screener ID from the hardcopy of the screener in the top right.

• More information is available from EPA's Contractor by electronic mail at cbmscreener@pgenv.com or by 

telephone at 1-800-764-4414.

Click to go to 

Item A-E User 

• Please refer to the accompanying Instruction Guide for help in answering specific questions.

• Please type in the screener address from the hardcopy of the screener into the address label section above.

2008 Coalbed Methane Industry Screener

Instructions:

YOUR RESPONSE IS REQUIRED 

BY LAW. Title 33, United States 

Code, requires businesses and other 

organizations that receive this 

questionnaire to answer the 

questions and return the report to the 

U.S. Environmental Protection 

Agency.

By the same law, you may claim 

confidentiality. See Instruction 

Guide for further information.

[ADDRESS LABEL]
Click to go to Instruction 

Guide

Worksheet Section

Click to go to Cover Page Item A

Item B

Item C

Item D

Item E

Click to go to Item A-C

Item A-C

Item D-E

Description

The hardcopy of the screener survey that you received in the mail contained an establishment name in the mailing 

address label. You should have also filled in this information in the Address Label box on the Cover Page worksheet. 

This section asks you to confirm if the establishment name on the address label was correct. The cell to the right of 

the question is a dropdown menu, so when you click on the box an arrow will appear to the right of the box. If you 

click on the arrow a list will come up with the choices "Yes" or "No". If you select "Yes" the cell to the right will 

highlight blue meaning that you do not need to type in the establishment name. If you select "No" the cell to the right 

will not highlight and you should type in the correct establishment name.

Item B asks you to fill in a contact person in case we have any questions about your responses. Please fill in the 

Name, Street Address, City, State, Zip, Phone, and E-mail in the appropriate sections.

Item D includes two questions. The first question asks if the highest level of corporate ownership in 2008 was a 

small business. There is a table to the right with the common size standards that you should use to help you answer 

the question. The cell to the right of the question is a dropdown menu, so when you click on the box an arrow to the 

right of the box will appear. If you click on the arrow a list will come up with the choices "Yes" or "No" and you should 

then select the appropriate response. The second question below, asks you to give an approximate date for the 

availability of your 2008 fiscal year financial data. Please be as specific as possible.

Item C asks if your establishment owned or operated any coalbed methane wells in 2008 only. The cell to the right of 

the question is a dropdown menu, so when you click on the box an arrow will appear to the right of the box. If you 

click on the arrow a list will come up with the choices "Yes" or "No". Please follow the instructions to the right of the 

dropdown menu cell when you have selected the appropriate response. 

Item E asks you how many projects your establishment owned or operated. You will be asked to list these projects 

and provide more specific information on these projects in Item F. 

***Note: Item F has its own User Guide***

Item A-E User Guide

This is a users guide for Item A-E. Item A-C are together on one worksheet, while Item D-E are on a separate worksheet together. This 

guide is broken down by worksheet and the specific section within the worksheet.
Return to Instruction 

Guide

If No, please enter establishment name

Return to Cover Page

Return to Item A-E User Guide

Name:

Street Address:

City, State, Zip:

Phone:

Email:

If Yes, Go to Item D Click to go to Item D-E

If No, return the survey to the address in the Instruction 

Guide.

Click to go to Remarks

At any time in 2008, did your 

establishment own or operate any 

coalbed methane wells?

Item C: Operating Status In 2008

Is the establishment name 

shown in the mailing address 

correct?

Item A: Establishment Name

Item B: Contact Information

If we have any questions about your response, who may we contact?
Return to Instruction Guide

NAICS Name of Industry

Small Business Administration 

(SBA) Size Standard

211xxx Oil and Gas Extraction < 500 employees

21211x Coal Mining < 500 employees

Return to Cover Page 213111 Drilling Oil and Gas Wells < 500 employees

213112 Support Activities for Oil and Gas Operations < $6.5 million annual revenues

213113 Support Activities for Coal Mining < $6.5 million annual revenues Click to go to Remarks

22111x Electric Power Generation < 4 million megawatt-hours/year

221112 Fossil Fuels Electric Power Generation < 4 million megawatt-hours/year

, 2009 22112x Electric Power, Transmission, Control and 

Distribution < 4 million megawatt-hours/year

22121x Natural Gas Distribution < 500 employees

32411x Petroleum Refineries < 1,500 employees

Return to Item A-C 486110 Pipeline Transportation of Crude Oil < 1,500 employees

486210 Pipeline Transportation of Natural Gas < $6.5 million annual revenues

Projects

Click to go to Item F User Guide

In 2008, how many CBM projects did your establishment own 

or operate?

A project in this survey is defined as a well, group of wells, lease, group of leases, or some other recognized unit that your establishment operates 

as an economic unit when making production decisions.

Item E: Number of Projects

Return to Item A-E User 

Guide

Month

When will your financial data for fiscal year 2008 be available? 

EPA will accept either audited or unaudited financial data.

Item D: Business Size

In 2008, was your highest level of corporate 

ownership a small business? (see common size 

standards on the right or contact helpline at 1- 800-

764-4414 or e-mail cbmscreener@pgenv.com for 

additional assistance)
Click to Return to 

Instruction Guide Click to enter Item F Project Information

Worksheet Column Description

Project Name or Identifier The name and/or number of the coalbed methane project. This name or identifier is automatically carried over into the Contact Information 

worksheet. Edits to the “Project Name or Identifier” must be made in the Project Information worksheet.

Project Location

This column includes 2 cells, "Basin (e.g., Powder River)" and "State (2-letter abbreviation)." Please put the basin that the specific project is 

located in and the state 2-letter abbreviation in their respective cells. Please indicate a basin name that you use and other operators would 

recognize. 

Did you buy or sell this project 

during 2008?

This column consists of 2 cells, "Yes or No" and "If Yes, what month?". The first cell, "Yes or No" is a dropdown menu. When you click on the 

cell, an arrow will appear to the right of the cell and when you click on the arrow the choices "Yes" and "No" will appear. When you select "Yes" 

the cell to the right will turn from blue to white indicating that you should answer the question "If Yes, what month?". If you select "No" the cell to 

the right will remain blue indicating that you do not need to fill in the neighboring cell.

Number of wells for this project 

in 2008 This should be the number of wells in the specific project identified in the “Project Name or Identifier” column for 2008 alone. 

Combined gas production from 

wells in 2008

This should be the number of the combined (total) gas production from the wells for the specific project identified in the “Project Name or 

Identifier” column for 2008 alone. 

Units

These cells are referring to the units used in the neighboring cell for the “Combined gas production from wells in 2008.” This column is made up 

of two cells, “Thousands of Cubic Feet (Mcf) or Other” and “If Other, enter reporting units.” The first cell, “Thousands of Cubic Feet or Other,” is a 

drop-down menu. When you click on the cell an arrow appears to the right of the cell. By clicking on the arrow you can select “Thousands of 

Cubic Feet” or “Other.” The default unit is Thousands of Cubic Feet (Mcf) and automatically appears in all the cells in the column. If you are 

reporting your “Combined gas production from wells in 2008” in other units, please select "Other" and put the units you are using in the “If Other, 

enter reporting units” cell.

How did you manage your 

process water?

This column consists of 8 cells, including “Discharge to surface water," ” Discharge to publicly owned treatment works,” “Land application,” 

“Underground injection,” “Evaporation or infiltration pond,” "Livestock or wildlife watering," "Trucked or transported off-site to a 3rd party", and 

"No water produced." The option "Discharge to POTW" is referring to any discharges to a publicly owned treatment works. The option "Land 

application" is referring to any discharges applied to land with or without crop production. Each cell is a drop-down menu. When you click on the 

cell, an arrow will appear to the right of the cell and when you click on the arrow an "X" will appear. Place an "X" under every method that you 

used to manage your process water. If you accidentally select an "X" from the drop-down menu, you must hit the Delete key to clear the cell. 

Please click to enter contact 

person information By clicking the arrow you are directed to the Contact Information worksheet.

Remarks: Please click to clarify 

your responses, if appropriate By clicking the arrow you are directed to the Remarks worksheet.

Worksheet Column Description

Click to return to Project 

Information By clicking the arrow above you are returned to the Project Information worksheet.

Project Name or Identifier

The project name or identifier is automatically filled in based on what was identified as the project name or identifier in the Project Information 

worksheet. This column is locked, so in order to edit the project name or identifier you must return to the Project Information worksheet and make 

the edit there. 

If this project is selected where 

should we send the second 

questionnaire?

The cells in this column appear as drop-down menus. When you click on the cell an arrow will appear to the right of the cell. By clicking on the 

arrow you can select one of the three choices. The choices are “To the same contact person identified in Item B,” “To the same person identified 

in the previous project,” and “Other (Please identify contact person).” If you select “Other (Please identify contact person),” the neighboring cell in 

the “Contact Information required?” column will appear highlighted with “Yes” in the cell. The neighboring cells in the “Name,” "Employer," “Street 

Address,” “City, State, Zip,” “Phone,” and “Email” columns will change from royal blue to white, allowing you to enter the contact person 

information for that project in those cells. 

Contact Information required? This cell is automatically filled in with “Yes” highlighted yellow, or “No” depending on your response to the question “If this project is selected 

where should we send the second questionnaire?” in the neighboring cell. 

Name Project contact person name. This information is required if the cell appears white. This information is not required if the cell appears royal blue. 

Employer The establishment name or name of your consulting firm. This information is required if the cell appears white. This information is not required if 

the cell appears royal blue. 

Street Address Project contact person mailing street address. This information is required if the cell appears white. This information is not required if the cell 

appears royal blue.

City, State, Zip Project contact person city, state, and zip code. This information is required if the cell appears white. This information is not required if the cell 

appears royal blue.

Phone Project contact person phone number with area code. This information is required if the cell appears white. This information is not required if the 

cell appears royal blue.

Email Contact person email address. This information is required if the cell appears white. This information is not required if the cell appears royal blue.

Remarks: Please click to clarify 

your responses, if appropriate By clicking the arrow below you are directed to the Remarks worksheet.

Worksheet Column Description

Click to return to Project 

Information By clicking the arrow above you are returned to the Project Information worksheet.

Click to return to Contact 

Information By clicking the arrow above you are returned to the Contact Information worksheet

Item F Remarks

This section should be used to clarify Item F responses, including identifying project-specific confidential business information. The first column in 

the Item F Remarks section is for the Project Name or Identifier and it is automatically filled in based on what you identified as the Project Name 

or Identifier in the Project Information worksheet. The second column is for making remarks. Please match up your remarks with the Project 

Name or Identifier that they are in reference to. 

General and Items A-E Remarks

This section should be used to clarify general survey and Items A-E responses, including identifying any confidential business information. The 

first column in the General and Items A-E Remarks section is a dropdown menu. Please select "General," "Item A," "Item B," "Item C," "Item D," 

or "Item E" for the Item that your remark is in reference to. You should make your General and Items A-E Remarks in the next column. 

Remarks

Item F CBM Project Information User Guide

This is a user guide that corresponds to each column in each worksheet. If you need assistance please contact the CBM telephone helpline at 1-800-764-4414 or email 

cbmscreener@pgenv.com

Project Information

Contact Information
Basin (e.g., 

Powder River)

State (2-letter 

abbreviation) Yes or No If Yes, what month? Thousands of Cubic Feet (Mcf) or Other If "Other" enter reporting units Discharge to surface water

Discharge to publicly 

owned treatment works Land application Underground injection Evaporation or infiltration pond

Livestock or wildlife 

watering

Trucked or transported 

off-site to a 3rd party No water produced

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Thousands of Cubic 

Feet (Mcf)

Units Remarks: Please 

click to clarify your 

responses, if 

appropriate

How did you manage your processed water? Select all that apply

Click to Return to the 

Item F User Guide

Project Location Did you buy or sell this project during 2008? Please click to enter 

contact person 

information

Click to Return to 

Instruction Guide

Project Name or Identifier (If none 

exists, then assign identifiers A, B, 

C, etc.)

Maximum number of 

CBM wells producing 

gas and/or water in 

2008

Combined gas 

production from wells 

in 2008
0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

0 No

Contact information 

required?

If this project is selected where should we send the 

second questionnaire? Name

Click to Return to Item 

A-C

Project Name or Identifier

Click to Return to 

Project Information

Click to Return to Item 

F User Guide

Click to Return to 

Instruction Guide

Employer

Email

Remarks: Please click 

to clarify your 

responses, if 

appropriate

Street Address City, State, Zip Phone

Item Letter Remarks Project Name or Identifier Remarks

Click to Return to 

Instruction Guide 0

0

Click to Return to Item 

F User Guide 0

0

Click to Return to 

Project Information 0

0

Click to Return to 

Contact Information 0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

General and Items A-E Remarks Item F Remarks