OMB CONTROL NO. 2090-0030

APPROVED: 05/01/2008 

APPROVAL EXPIRES: 12/22/2013 

 

MBE/WBE UTILIZATION UNDER FEDERAL GRANTS 

AND COOPERATIVE AGREEMENTS 

PART I. (Reports are required even if no procurements are made during the reporting period.) 

1A. FEDERAL FISCAL YEAR

 (Oct. 1-Sep 30)

 20_______

1B. REPORTING PERIOD (Check ALL appropriate boxes)

 □ 1

st (Oct-Dec) □ 2nd (Jan-Mar) □ 3rd (Apr-Jun) □ 4th (Jul-Sep) 

 □ Semi-Annual (Oct-Mar) □ Semi-Annual (Apr-Sep) 

 □ Annual

□ Check if this is the last report for the project (Project completed).

1C. REVISION OF A PRIOR REPORT? Y 

or N Year: _________

 Quarter: _________

BRIEFLY DESCRIBE THE REVISIONS YOU ARE MAKING:

2A. EPA FINANCIAL ASSISTANCE OFFICE ADDRESS ( ATTN: DBE 

Coordinator)

3A. RECIPIENT NAME AND ADDRESS

2B. EPA DBE COORDINATOR

Name:

E-mail:

2C. PHONE:

Fax:

3B. RECIPIENT REPORTING CONTACT:

Name:

E-mail:

3C. PHONE:

Fax:

4A. FINANCIAL ASSISTANCE AGREEMENT ID NUMBER

 (SRF State Recipients, refer to Instructions for Completion of blocks

 4A, 5A and 5C.)

4B. FEDERAL FINANCIAL ASSISTANCE PROGRAM TITLE or CFDA 

 NUMBER:

5A. TOTAL ASSISTANCE AGREEMENT AMOUNT

(SRF State Recipients, refer to Instructions for Completion of blocks 

4A, 5A and 5C.)

 EPA Share: $_______________________

 Recipient Share: $_____________________

5B. If NO procurement and NO accomplishments were made this reporting period (by the 

recipients, sub-recipients, loan recipients, and prime contractors), CHECK and SKIP to Block 

No. 7. (Procurements are all expenditures through contract, order, purchase, lease or barter of 

supplies, equipment, construction, or services needed to complete Federal assistance 

programs. Accomplishments, in this context, are procurements made with MBEs and/or WBEs. 

 □

5C. Total Procurements This Reporting Period

 (Only include amount not reported in any prior reporting period)

Total Procurement Amount $________________________ (Include total dollar values awarded by recipient, sub-recipients and SRF loan recipients, 

including MBE/WBE expenditures.)

5D.

Were sub-awards issued under this assistance agreement? Yes___ No____ Were contracts issued under this assistance agreement ? Yes____ No___

5E. MBE/WBE Accomplishments This Reporting Period

Actual MBE/WBE Procurement Accomplished:

(Include total dollar values awarded by recipient, sub-recipients, SRF loan recipients and Prime Contractors.)

 Construction Equipment Services Supplies Total

 $MBE: ____________ _____________ _____________ _____________ ________________

 

 $WBE: ____________ ______________ ______________ _____________ ________________

6. COMMENTS: (If no MBE/WBE procurements were accomplished during the reporting period, please explain what steps you are taking to achieve the 

MBE/WBE Program requirements specified in the terms and conditions of the Assistance Agreement.)

7. NAME OF RECIPIENT’S AUTHORIZED 

REPRESENTATIVE

TITLE

8. SIGNATURE OF RECIPIENT’S AUTHORIZED 

REPRESENTATIVE

DATE

EPA FORM 5700-52A available electronically at http://www.epa.gov/osbp/pdfs/5700_52a.pdf

 United States ENVIRONMENTAL PROTECTION AGENCY Washington, DC 20460
PART II. MBE/WBE PROCUREMENTS MADE DURING REPORTING PERIOD 

EPA Financial Assistance Agreement Number: _______________

Type of product or service codes:

 1 = Construction 2 = Supplies 3 = Services 4 = Equipment 

Note: Refer to Terms and conditions of your Assistance Agreement to determine the frequency of reporting. Recipients are required to submit MBE/WBE reports to EPA beginning with the Federal fiscal year quarter 

the recipients receive the award, continuing until the project is completed. 

EPA FORM 5700-52A - (Approval Expires 12/22/13)

1. Procurement Made By 2. Business 

Enterprise

3. $ Value of 

 Procurement

4. Date of 

Procurement

MM/DD/YY

5. Type of 

Product or 

ServicesA

(Enter Code)

6. Name/Address/Phone Number of MBE/WBE 

Contractor or Vendor

Recipient SubRecipient 

and/or SRF

Loan 

Recipient

Prime Minority Women
Instructions: 

A. General Instructions: 

MBE/WBE utilization is based on 40 CFR Part 33. EPA 

Form 5700-52A must be completed by recipients of 

Federal grants, cooperative agreements, or other Federal 

financial assistance which involve procurement of 

supplies, equipment, construction or services to 

accomplish Federal assistance programs. 

Recipients are required to report 30 days after the end of 

each federal fiscal quarter, semiannually, or annually, per 

the terms and conditions of the financial assistance 

agreement. 

 

Quarterly 

Reporting

Due Date

Semiannual 

Reporting

Due Date

Annual 

Reporting

Due Date

Agreements 

awarded

prior to May 

27, 2008

January 30, 

April 30,

July 30, 

October 30

N/A October 

30

Agreements 

awarded on 

or after May 

27, 2008

N/A April 30, 

October 30

October 

30

MBE/WBE program requirements, including reporting, are 

material terms and conditions of the financial assistance 

agreement. 

B. Definitions: 

Procurement is the acquisition through contract, order, 

purchase, lease or barter of supplies, equipment, 

construction or services needed to accomplish Federal 

assistance programs. 

A contract is a written agreement between an EPA 

recipient and another party (also considered “prime 

contracts”) and any lower tier agreement (also considered 

“subcontracts”) for equipment, services, supplies, or 

construction necessary to complete the project. This 

definition excludes written agreements with another public 

agency. This definition includes personal and 

professional services, agreements with consultants, and 

purchase orders. 

A minority business enterprise (MBE) is a business 

concern that is (1) at least 51 percent owned by one or 

more minority individuals, or, in the case of a publicly 

owned business, at least 51 percent of the stock is owned 

by one or more minority individuals; and (2) whose daily 

business operations are managed and directed by one or 

more of the minority owners. In order to qualify and 

participate as an MBE prime or subcontractor for EPA 

recipients under EPA’s DBE Program, an entity must be 

properly certified as required by 40 CFR Part 33, Subpart 

B.

U.S. citizenship is required. Recipients shall presume 

that minority individuals include Black Americans, 

Hispanic Americans, Native Americans, Asian Pacific 

Americans, or other groups whose members are found to 

be disadvantaged by the Small Business Act or by the 

Secretary of Commerce under section 5 of Executive 

order 11625. The reporting contact at EPA can provide 

additional information. 

A woman business enterprise (WBE) is a business 

concern that is, (1) at least 51 percent owned by one or 

more women, or, in the case of a publicly owned 

business, at least 51 percent of the stock is owned by one 

or more women and (2) whose daily business operations 

are managed and directed by one or more of the women 

owners. In order to qualify and participate as a WBE 

prime or subcontractor for EPA recipients under EPA’s 

DBE Program, an entity must be properly certified as 

required by 40 CFR Part 33, Subpart B. 

 

Business firms which are 51 percent owned by minorities 

or women, but are in fact managed and operated by nonminority individuals do not qualify for meeting MBE/WBE 

procurement goals. U.S. Citizenship is required. 

Good Faith Efforts

A recipient is required to make the following good faith 

efforts whenever procuring construction, equipment, 

services, and supplies under an EPA financial assistance 

agreement. These good faith efforts for utilizing MBEs 

and WBEs must be documented. Such documentation is 

subject to EPA review upon request: 

1. Include of MBEs/WBEs on solicitation lists.

2. Assure that MBEs/WBEs are solicited once they 

are identified. 

3. Divide total requirements into smaller tasks to 

permit maximum MBE/WBE participation, where 

feasible. 

4. Establish delivery schedules which will encourage 

MBE/WBE participation, where feasible. 

5. Encourage use of the services of the U.S. 

Department of Commerce's Minority Business 

Development Agency (MBDA) and the U.S. Small 

Business Administration to identify MBEs/WBEs. 
6. Require that each party to a subgrant, 

subagreement, or contract award take the good 

faith efforts outlined here. 

C. Instructions for Part I: 

1a. Specify Federal fiscal year this report covers. The 

Federal fiscal year runs from October 1st through 

September 30th (e.g. November 29, 2010 falls 

within Federal fiscal year 2011) 

1b. Check applicable reporting box, quarterly, 

semiannually, or annually. Also indicate if this is 

the last report for the project. 

1c. Indicate if this is a revision to a previous year, 

half-year, or quarter, and provide a brief 

description of the revision you are making. 

2a-c. Please refer to your financial assistance 

agreement for the mailing address of the EPA 

financial assistance office for your agreement. 

The “EPA DBE Reporting Contact” is the DBE 

Coordinator for the EPA Region from which your 

financial assistance agreement was originated. 

For a list of DBE Coordinators please refer to the 

EPA OSBP website at www.epa.gov/osbp. Click 

on “Regional Contacts” for the name of your 

coordinator. 

3a-c. Identify the agency, state authority, university or 

other organization which is the recipient of the 

Federal financial assistance and the person to 

contact concerning this report. 

4a. Provide the Assistance Agreement number 

assigned by EPA. A separate report must be 

submitted for each Assistance Agreement. 

*For SRF recipients: In box 4a list numbers for 

ALL OPEN Assistance Agreements being 

reported on this form. Please note that although 

the New DBE Rule (which took effect May 27, 

2008) revised the reporting frequency 

requirements from quarterly to semiannually, that 

change only applies to agreements awarded 

AFTER the New DBE Rule took effect. 

Therefore, SRF recipients may either continue to 

report activity for all Agreements on one form on 

a quarterly basis until the last award that was 

made prior to the New DBE Rule has been closed 

out; OR, the recipient may split the submission of 

SRF reports into quarterly reports for Agreements 

awarded prior the New DBE Rule, and 

semiannually for the awards made after the New 

DBE Rule. 

4b. Refer back to Assistance Agreement document 

for this information. 

5a. Provide the total amount of the Assistance 

Agreement which includes Federal funds plus 

recipient matching funds and funds from other 

sources. 

*For SRF recipients only: SRF recipients will not 

enter an amount in 5a. Please leave 5a blank. 

5b. Self-explanatory. 

5c. Provide the total dollar amount of ALL 

procurements awarded this reporting period by 

the recipient, sub-recipients, and SRF loan 

recipients, including MBE/WBE expenditures. 

For example: Actual dollars for procurement from 

the procuring office; actual contracts let from the 

contracts office; actual goods, services, supplies, 

etc., from other sources including the central 

purchasing/ procurement centers). 

 

*NOTE: To prevent double counting on line 5C, if 

any amount on 5E is for a subcontract and the 

prime contract has already been included on Line 

5C in a prior reporting period, then report the 

amount going to MBE or WBE subcontractor on 

line 5E, but exclude the amount from Line 5C. To 

include the amount on 5C again would result in 

double counting because the prime contract, 

which includes the subcontract, would have 

already been reported. 

 

5d. State whether or not sub-awards and/or 

subcontracts have been issued under the 

assistance agreement by indicating “yes” or “no”. 

5e. Where requested, also provide the total dollar 

amount of all MBE/WBE procurement awarded 

during this reporting period by the recipient, subrecipients, SRF loan recipients, and prime 

contractors in the categories of construction, 

equipment, services and supplies. These 

amounts include Federal funds plus recipient 

matching funds and funds from other sources. 

*For SRF recipients only: In 5c please enter the 

total procurement amount for the quarter, or 

semiannual period, under all of your SRF 

Assistance Agreements. The figure reported in 

this section is not directly tied to an individual 

Assistance Agreement identification number. 

(SRF state recipients report state 

procurements in this section)

 

6. If there were no MBE/WBE accomplishments this 

reporting period, please briefly explain what 
specific steps you are taking to achieve the 

MBE/WBE requirements specified in the terms 

and conditions of the Assistance Agreement. 

7. Name and title of official administrator or 

designated reporting official. 

8. Signature, month, day, and year report submitted. 

D. Instructions for Part II:

For each MBE/WBE procurement made under this 

assistance agreement during the reporting period, provide 

the following information: 

1. Check whether this procurement was made by 

the recipient, sub-recipient/SRF loan recipient, or 

the prime contractor. 

2. Check either the MBE or WBE column. If a firm 

is both an MBE and WBE, the recipient may 

choose to count the entire procurement towards 

EITHER its MBE or WBE accomplishments. The 

recipient may also divide the total amount of the 

procurement (using any ratio it so chooses) and 

count those divided amounts toward its MBE and 

WBE accomplishments. If the recipient chooses 

to divide the procurement amount and count 

portions toward its MBE and WBE 

accomplishments, please state the appropriate 

amounts under the MBE and WBE columns on 

the form. The combined MBE and WBE 

amounts for that MBE/WBE contractor must 

not exceed the “Value of the Procurement” 

reported in column #3

3. Dollar value of procurement. 

4. Date of procurement, shown as month, day, year. 

Date of procurement is defined as the date the 

contract or procurement was awarded, not the 

date the contractor received payment under the 

awarded contract or procurement, unless 

payment occurred on the date of award. (Where 

direct purchasing is the procurement method, 

the date of procurement is the date the 

purchase was made)

5. Using codes at the bottom of the form, identify 

type of product or service acquired through this 

procurement (e.g., enter 1 if construction, 2 if 

supplies, etc). 

6. Name, address, and telephone number of 

MBE/WBE firm.

**This data is requested to comply with provisions 

mandated by: statute or regulations (40 CFR Part 30, 31, 

and 33); OMB Circulars; or added by EPA to ensure 

sound and effective assistance management. Accurate, 

complete data are required to obtain funding, while no 

pledge of confidentiality is provided. 

 The public reporting and recording burden for this 

collection of information is estimated to average l hour per 

response annually. Burden means the total time, effort, 

or financial resources expended by persons to generate, 

maintain, retain, or disclosure or provide information to or 

for a Federal agency. 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 the 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. 

 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, OPPE 

Regulatory Information Division, U.S. Environmental 

Protection Agency (2136), 1200 Pennsylvania Avenue, 

NW, Washington, D.C. 20460. Include the OMB Control 

number in any correspondence. Do not send the 

completed form to this address.