Form Approved OMB No:2030-0020 Approval Expires 04/2012



### KEY CONTACTS FORM

Authoriz ed Representative: Original awards and amendments will be sent to this individual for review and acceptance, unless otherwise indicated.

Name: __________________________________________________________________________ Title: ___________________________________________________________________________ Complete Address: ________________________________________________________________

________________________________________________________________ Phone Number: ___________________________________________________________________



### Payee: Individual authorized to accept payments.

Name: __________________________________________________________________________ Title: ___________________________________________________________________________ Mail Address: ____________________________________________________________________

________________________________________________________________________________ Phone Number: ___________________________________________________________________



### Administrative Contact: Individual from Sponsored Program Office to contact concerning administrative matters (i.e., indirect cost rate computation, rebudgeting requests etc.)

Name: __________________________________________________________________________ Title: ___________________________________________________________________________ Mailing Address: __________________________________________________________________

________________________________________________________________________________ Phone Number: ___________________________________________________________________ FAX Number: ____________________________________________________________________ E-Mail Address: __________________________________________________________________



### Principal Investigator: Individual responsible fo r the technical completi on of the proposed work.

Name: __________________________________________________________________________ Title: ___________________________________________________________________________ Mailing Address: __________________________________________________________________

________________________________________________________________________________ Phone Number: ___________________________________________________________________ FAX Number: ____________________________________________________________________ E-Mail Address: __________________________________________________________________ Web URL: _______________________________________________________________________

EPA Form 5700-54 (Rev 04/2012 ) U.S. ENVIRONMENTAL PROTECTION AGENCY Washington, DC 20460

The public reporting and recordkeeping burden for this collection of information is estimated to average 30 minutes 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.