FORM Approved By OMB: No. 2030-0020 Expires 04-30-201 . 2

 

Preaward Compliance Review Report for 

All Applicants and Recipients Requesting EPA Financial Assistance 

Note: Read instructions on other side before completing form.

I. Applicant/Recipient (Name, Address, State, Zip Code). DUNS No. 

II. Is the applicant currently receiving EPA assistance? 

III. List all civil rights lawsuits and administrative complaints pending against the applicant/recipient that allege discrimination based on race, 

color, national origin, sex, age, or disability. (Do not include employment complaints not covered by 40 C.F.R. Parts 5 and 7. See 

instructions on reverse side.) 

IV. List all civil rights lawsuits and administrative complaints decided against the applicant/recipient within the last year that allege 

discrimination based on race, color, national origin, sex, age, or disability and enclose a copy of all decisions. Please describe all corrective 

action taken. (Do not include employment complaints not covered by 40 C.F.R. Parts 5 and 7. See instructions on reverse side.) 

V. List all civil rights compliance reviews of the applicant/recipient conducted by any agency within the last two years and enclose a copy of the 

review and any decisions, orders, or agreements based on the review. Please describe any corrective action taken. (40 C.F.R. § 7.80(c)(3)) 

VI. Is the applicant requesting EPA assistance for new construction? If no, proceed to VII; if yes, answer (a) and/or (b) below. 

a. If the grant is for new construction, will all new facilities or alterations to existing facilities be designed and constructed to be readily 

accessible to and usable by persons with disabilities? If yes, proceed to VII; if no, proceed to VI(b). 

b. If the grant is for new construction and the new facilities or alterations to existing facilities will not be readily accessible to and usable by 

persons with disabilities, explain how a regulatory exception (40 C.F.R. § 7.70) applies. 

VII.* Does the applicant/recipient provide initial and continuing notice that it does not discriminate on the basis of race, color, national origin, sex, 

age, or disability in its programs or activities? (40 C.F.R. § 5.140 and § 7.95) 

a. Do the methods of notice accommodate those with impaired vision or hearing? 

b. Is the notice posted in a prominent place in the applicant’s offices or facilities or, for education programs and activities, in appropriate 

periodicals and other written communications? 

c. Does the notice identify a designated civil rights coordinator? 

VIII.* Does the applicant/recipient maintain demographic data on the race, color, national origin, sex, age, or handicap of the population it serves? 

(40 C.F.R. § 7.85(a)) 

IX.* Does the applicant/recipient have a policy/procedure for providing access to services for persons with limited English proficiency? 

(40 C.F.R. Part 7, E.O. 13166) 

X.* If the applicant/recipient is an education program or activity, or has 15 or more employees, has it designated an employee to coordinate its 

compliance with 40 C.F.R. Parts 5 and 7? Provide the name, title, position, mailing address, e-mail address, fax number, and telephone 

number of the designated coordinator. 

XI* If the applicant/recipient is an education program or activity, or has 15 or more employees, has it adopted grievance procedures that assure 

the prompt and fair resolution of complaints that allege a violation of 40 C.F.R. Parts 5 and 7? Provide a legal citation or Internet address 

for, or a copy of, the procedures. 

For the Applicant/Recipient 

I certify that the statements I have made on this form and all attachments thereto are true, accurate and complete. I acknowledge that any knowingly 

false or misleading statement may be punishable by fine or imprisonment or both under applicable law. I assure that I will fully comply with all 

applicable civil rights statutes and EPA regulations. 

A. Signature of Authorized Official B. Title of Authorized Official C. Date 

For the U.S. Environmental Protection Agency 

I have reviewed the information provided by the applicant/recipient and hereby certify that the applicant/recipient has submitted all preaward 

compliance information required by 40 C.F.R. Parts 5 and 7; that based on the information submitted, this application satisfies the preaward provisions 

of 40 C.F.R. Parts 5 and 7; and that the applicant has given assurance that it will fully comply with all applicable civil rights statutes and EPA 

regulations. 

A. Signature of Authorized EPA Official 

See ** note on reverse side. 

B. Title of Authorized EPA Official C. Date 

EPA Form 4700-4 (Rev. 04/2009). Previous editions are obsolete. 
Instructions for EPA FORM 4700-4 (Rev. 04/2009) 

General 

Recipients of Federal financial assistance from the U.S. 

Environmental Protection Agency must comply with the following 

statutes and regulations. 

Title VI of the Civil Rights Acts of 1964 provides that no person in 

the United States shall, on the grounds of race, color, or national 

origin, be excluded from participation in, be denied the benefits of, or 

be subjected to discrimination under any program or activity 

receiving Federal financial assistance. The Act goes on to explain 

that the statute shall not be construed to authorize action with respect 

to any employment practice of any employer, employment agency, or 

labor organization (except where the primary objective of the Federal 

financial assistance is to provide employment). 

Section 13 of the 1972 Amendments to the Federal Water Pollution 

Control Act provides that no person in the United States shall on the 

ground of sex, be excluded from participation in, be denied the 

benefits of, or be subjected to discrimination under the Federal Water 

Pollution Control Act, as amended. Employment discrimination on 

the basis of sex is prohibited in all such programs or activities. 

Section 504 of the Rehabilitation Act of 1973 provides that no 

otherwise qualified individual with a disability in the United States 

shall solely by reason of disability be excluded from participation in, 

be denied the benefits of, or be subjected to discrimination under any 

program or activity receiving Federal financial assistance. 

Employment discrimination on the basis of disability is prohibited in 

all such programs or activities. 

The Age Discrimination Act of 1975 provides that no person on the 

basis of age shall be excluded from participation under any program 

or activity receiving Federal financial assistance. Employment 

discrimination is not covered. Age discrimination in employment is 

prohibited by the Age Discrimination in Employment Act 

administered by the Equal Employment Opportunity Commission. 

Title IX of the Education Amendments of 1972 provides that no 

person in the United States on the basis of sex shall be excluded from 

participation in, be denied the benefits of, or be subjected to 

discrimination under any education program or activity receiving 

Federal financial assistance. Employment discrimination on the basis 

of sex is prohibited in all such education programs or activities. 

Note: an education program or activity is not limited to only those 

conducted by a formal institution. 

40 C.F.R. Part 5 implements Title IX of the Education Amendments 

of 1972. 

40 C.F.R. Part 7 implements Title VI of the Civil Rights Act of 1964, 

Section 13 of the 1972 Amendments to the Federal Water Pollution 

Control Act, and Section 504 of The Rehabilitation Act of 1973. 

The Executive Order 13166 (E.O. 13166) entitled; "Improving 

Access to Services for Persons with Limited English Proficiency" 

requires Federal agencies work to ensure that recipients of Federal 

financial assistance provide meaningful access to their LEP 

applicants and beneficiaries. 

 

Items 

“Applicant” means any entity that files an application or unsolicited 

proposal or otherwise requests EPA assistance. 40 C.F.R. §§ 5.105, 

7.25. 

“Recipient” means any entity, other than applicant, which will actually 

receive EPA assistance. 40 C.F.R. §§ 5.105, 7.25. 

“Civil rights lawsuits and administrative complaints” means any 

lawsuit or administrative complaint alleging discrimination on the 

basis of race, color, national origin, sex, age, or disability pending or 

decided against the applicant and/or entity which actually benefits 

from the grant, but excluding employment complaints not covered by 

40 C.F.R. Parts 5 and 7. For example, if a city is the named applicant 

but the grant will actually benefit the Department of Sewage, civil 

rights lawsuits involving both the city and the Department of Sewage 

should be listed. 

“Civil rights compliance review” means any review assessing the 

applicant’s and/or recipient’s compliance with laws prohibiting 

discrimination on the basis of race, color, national origin, sex, age, or 

disability. 

Submit this form with the original and required copies of applications, 

requests for extensions, requests for increase of funds, etc. Updates of 

information are all that are required after the initial application 

submission. 

If any item is not relevant to the project for which assistance is 

requested, write “NA” for “Not Applicable.” 

In the event applicant is uncertain about how to answer any questions, 

EPA program officials should be contacted for clarification. 

* Questions VII – XI are for informational use only and will not affect 

an applicant’s grant status. However, applicants should answer all 

questions on this form. (40 C.F.R. Parts 5 and 7). 

** Note: Signature appears in the Approval Section of the EPA 

Comprehensive Administrative Review For Grants/Cooperative 

Agreements & Continuation/Supplemental Awards form. 

Approval indicates, in the reviewer’s opinion, questions I – VI of Form 

4700-4 comply with the preaward administrative requirements for EPA 

assistance. 

“Burden Disclosure Statement” 

EPA estimates public reporting burden for the preparation of this form 

to average 30 minutes per response. This estimate includes the time 

for reviewing instructions, gathering and maintaining the data needed 

and completing and reviewing the form. Send comments regarding the 

burden estimate, including suggestions for reducing this burden, to 

U.S. EPA, Attn: Collection Strategies Division (MC 2822T), Office of 

Information Collection, 1200 Pennsylvania Ave., NW, Washington, 

D.C. 20460; and to the Office of Information and Regulatory Affairs, 

Office of Management and Budget, Washington, D.C. 20503. 

The information on this form is required to enable the U.S. 

Environmental Protection Agency to determine whether applicants and 

prospective recipients are developing projects, programs and activities 

on a nondiscriminatory basis as required by the above statutes and 

regulations.