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

 KEY CONTACTS FORM 

Authorized 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 for the technical completion 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.