Document ID: EPA-HQ-OA-2007-0706-0009
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2015-04-30T04:00Z

STATE SMALL BUSINESS STATIONARY SOURCE

TECHNICAL AND ENVIRONMENTAL COMPLIANCE

ASSISTANCE PROGRAM (SBTCP)

ANNUAL REPORTING FORM

FOR THE PERIOD January 01, 2014 TO December 31, 2014

(We are collecting objective information on each SBTCP. This report is
not an evaluation of your program)

*** Completed forms are due by Friday, May 29, 2015***

This is the Annual Reporting Form for the State Small Business
Stationary Source Technical and Environmental Compliance Assistance
Programs (SBTCPs) under section 507 of the Clean Air Act (CAA) as
amended in 1990. For over 20 years, these programs known as the state
Small Business Ombudsman and Small Business Environmental Assistance
Programs (SBO/SBEAP) have provided extensive, hands-on assistance to
small businesses to help them understand and comply with environmental
regulations. The programs also advocate with the Environmental
Protection Agency (EPA) to issue regulations that are relatively simple
to implement and clear and easy for small businesses to comply with. 

The public reporting and recordkeeping burden for this collection of
information is estimated to average 4 hours 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.

NOTE: This survey captures data on the assistance efforts of diverse
state programs and program data will differ based on the specific
program structure and menu of services. Therefore, if you do not have
all the information requested, you may leave sections blank. 

INSTRUCTIONS FOR COMPLETING THIS FORM

1. Save this document (using the "Save As" function from the File menu)
to your hard drive using the name of your State or Territory and the
date as the document title before continuing.

2. Please complete this form in whatever version works best for you. 
You may complete this form in Microsoft Word, Adobe, or print out,
complete in hardcopy, then scan it back into an electronic version to be
returned by email. 

3. You should have already collected the requested information. If a
question asks for data you do not have, please briefly explain why it is
not available in the narrative box at the end of each section and/or at
the end of this document. For future reports, you may need to revise the
information that you track.

4. Each answer block (with the noted exceptions) must contain complete
information. If part of the question does not apply, indicate "not
applicable," "NA," “0,” or another appropriate answer. If you do not
collect a particular item, you can enter “not tracked” or “not
collected” or either abbreviation (NT or NC).  

5. Please do not answer questions by referring to attached documents or
a previous SBTCP report. Whenever possible respond to the questions with
the required data necessary to easily compile all the states information
cohesively.  

6. In the narrative section at the end of the form, you may cut and
paste text from another file. Text will be auto-formatted to fit the
allocated space.

7. Once your form is complete please e-mail a copy of the document to
Elnora Thompson   HYPERLINK "mailto:thompson.elnora@epa.gov" 
thompson.elnora@epa.gov  and Paula Hoag,   HYPERLINK
"mailto:Hoag.paula@epa.gov"  Hoag.paula@epa.gov .

8. If you have questions, contact Paula Hoag at 202 566-2496 or
hoag.paula@epa.gov.

ADDITIONAL SUGGESTIONS FOR COMPLETING THIS FORM

Gathering information for this report is a team effort! Enlist the help
of key contacts from the SBO, the SBEAP, and the CAP, and ask them to
complete applicable sections.

However, one person should take responsibility for completing and
submitting this Form.

Refer to last year's report when completing this year's Reporting Form.

PROGRAM INFORMATION

Name of State or Territory 	California

Report Contact Name

	Contact Phone Number

What Components of the 507 Program does your state have?

(      SBO             

(     CAP	(      SBEAP

(     Dual SBO/SBEAP (combined role in one person)

Are all three components reporting on this form?                        
(   Yes        (      No 

Component(s) not reporting:

	

	SBEAP

( Dual Role (SBO/SBEAP)	SBO

(Skip if dual role)	CAP Chair

Name Of Primary Contact

	Title

	Agency/Organization

	Street Address

	City, State, Zip

	Telephone Number

	Email Address

	Web Site

	

Where is each 507 program component administered or housed?  (for the
CAP, check box of agency who provides the professional staffing for your
CAP)	SBEAP	SBO	Dual Program

(SBO/SBEAP)	CAP

State Regulatory Agency

Local Regulatory Agency

Commerce/Economic Development Agency

Small Business Development Center

Private Contractor

College/University

Chamber of Commerce

Trade Group

Other __________________________________

STAFFING 

How many employees, measured as full-time equivalents (FTEs), support
the SBO & SBEAP?

If the SBEAP function is not full-time for staff, indicate the fraction
of FTE spent on the 507 program.  If funding sources for a position
include something other than dedicated for the 507 program (e.g., a
pollution prevention grant), indicate the fraction of FTE dedicated from
other funds outside the SBO/SBEAP staff numbers, in the "Other staff"
section. If a position was vacant at any point during the year, enter
that information in the "If vacant, percent of year vacant" column. 

Total FTEs  (FTE time/# staff)

[For example:  0.25 FTE/1 staff; 0.5 FTE/1.5 staff, etc.)	If vacant,
percent of year vacant

[For example: 1 FTE vacant 75% year]

SBEAP Staff: 

	SBO Staff:

	SBO/SBEAP Dual program staff:  

	Other staff:  

	

Staffing level:  ( Increased     ( Decreased     ( Remained the Same    

Change in staffing level was:  (Temporary     ( Permanent     

Comments on staffing changes:	

MEDIA 

What formal media (air, water, waste, etc.) services does your 507
program provide? 

Only check multimedia if providing media services other than air is a
required function of your program.

( Air Only

( Multimedia

	Check services in addition to air:  ( Water     ( Waste     ( Energy   
 ( P2     ( Other _____________________________

If your program does not offer a formal multimedia program, do you
provide limited services in other areas like water, waste, energy, etc.?
   	( Yes     ( No

Comments on multimedia:

.  

Of the SBO/SBEAP activities within your program, please provide a rough
estimate of the percentage of time spent on each media program or other
programs.  To estimate, programs may use such things as demands for
services like “% of helpline calls”, training, tool development, or
other initiatives focused on a particular media, or simply based off
budgeted/work plan levels.

Program	% Air	% Waste	% Water	% Other (enter description of other)

SBEAP

SBO

Dual (SBO/SBEAP)

CAP

□ Do not have this information but mainly air

□ Do not have this information but conduct activities in all media

BUDGET

SBEAP (or Dual Program) BUDGET

Record the budget for your SBEAP for the calendar year. If your budget
is by fiscal year (FY), report the FY budget that was in effect as of
12/31 of the calendar year used for reporting data. Explain any changes
to the budget in the comments box.

SBEAP Current Budget (as of 12/31)  

( Dual (SBO/SBEAP reported here)

	Contains CAP Funding	( Yes     ( No

Direct Annual CAP expenditures (if known)

	Budget Changes	( Increase     ( Decrease     ( No Change

	If budget changed, was it: ( Temporary     ( Permanent  

Budget Source(s) - check all that apply (if known)	( Air    ( Waste    
( Water 

( Other federal grants    ( Other state funds 

( Other (e.g., fees, SEP, donations; please list)
____________________________

SBO BUDGET

Record the budget for your SBO for the calendar year.  If your budget is
by fiscal year (FY), report the FY budget that was in effect as of 12/31
of the calendar year used for reporting data. Explain any changes to the
budget in the comments box.

SBO Current Budget (as of 12/31) 

(skip if Dual recorded above)

	Contains CAP Funding	( Yes     ( No

Direct Annual CAP expenditures (if known)	$

Budget Changes (if known)	( Increase     ( Decrease     ( No Change

	If budget changed, was it: ( Temporary     ( Permanent  

Budget Source(s) - check all that apply (if known)	( Air      ( Waste   
  ( Water 

( Other federal grants      ( Other state funds 

( Other (e.g., fees, SEP, donations; please list)
____________________________

Comments/ Explanations (additional sources, if other funding or changes,
describe)

COMPLIANCE ADVISORY PANEL (CAP)

Does your state have a CAP?	( Yes     	( No     	Total number of
positions :  

________	Number of vacant positions

________

Reason for any vacant positions in last FY	( Reduced funding     	(
Temporary vacancies    	( Not getting appointments      	(  Other :

Is your CAP active (holding meetings or conference calls)?	( Yes     	(
No     	( N/A     	# of meetings/calls held over the FY:  

Comments/ Explanations (describe any issues with CAP changes,
appointments, etc)

.

OUTREACH AND TECHNICAL ASSISTANCE

Check the box for the services or tools your state provides listed below
according to the entity (SBO/SBEAP/CAP) that provides the service or
tool. The service or tool should only be checked if the SBO/SBEAP/CAP
staff provided the service directly. Any services or tools provided that
are not listed below should be noted in the second table, "Other
Services/Tools Not Captured Above."  DO NOT enter counts of activities
in this table; that data should be provided in the Compliance Assistance
tables on page 7.  

Service/Tool Provided

(Check all provided by each component reporting here)	SBEAP	SBO	Dual
Role

(SBO/SBEAP)	CAP

Toll-free Helpline

Web site

Newsletter

Outreach via Social Media (Facebook, Twitter, Linked In etc)

Face-to-face Meetings

Seminars/Workshops

On-site Compliance Assessments

Individual Client Advocacy/Meeting Facilitation with regulatory staff

General Industry Advocacy: comments on state and federal rule
development,  serving on workgroups, etc.

Conflict Resolution/Regulatory Complaints

Direct Permit Application Preparation

Guidance Publications 

Recordkeeping Tools

Regulatory Forms Development

Electronic Tools Development (web-based training, spreadsheets, etc.)

Individual Regulatory Applicability Assistance

Industry Notification of New Rules

Return-to-compliance Assistance (referrals through enforcement action)

Environmental Results Program (ERP)

Listing of Environmental Consultants

Mentor Programs (SCORE, etc.)

Energy Assessments

P2 Assessments

Loan Programs

Grant Programs

Tax Credits

Referrals to other providers

Other Services/Tools Not Captured Above	SBEAP	SBO	Dual Role

(SBO/SBEAP)	CAP

Compliance Assistance

For the questions below, enter data for each compliance assistance
activity provided directly by the SBO or SBEAP for the calendar year. If
your program does not provide that service, enter N/A. In cases in which
an SBO and SBEAP work independently, identify efforts engaged by each
one as appropriate.  The “Dual” column is for programs that have
staff holding both roles.  

Compliance assistance includes activities, tools, and technical
assistance that help small businesses understand and meet their
obligations under environmental regulations. Compliance assistance may
also help small businesses find cost-effective solutions and/or go
beyond compliance through pollution prevention, environmental management
practices, and innovative technologies.

The first column, “Amount of Effort”, counts the number of
assistance activities provided, (for example, number of face to face
meetings held) not the number of individual businesses assisted. The
second column, "Number of Small Businesses Assisted by this Effort,"
counts the number of individual businesses for each assistance type.
Thus the same business may be counted in several assistance categories.
In contrast, the following table asks for the overall total number of
individual businesses assisted and is not a summation of the data in the
second tables under each question. If you do not track activities
exactly as described, estimate the data to the best of your ability. If
you find you are unable to include data in a particular area please note
that in the narrative section at the end of the main survey. 

Activities	AMOUNT OF EFFORT	NUMBER OF SMALL BUSINESSES ASSISTED BY THIS
EFFORT

	SBO	SBEAP	Dual Role	SBO	SBEAP	Dual Role

DIRECT CONTACTS

Phone calls or emails exchanged, and/or face-to-face meetings with
businesses, trade associations, federal offices, the general public, or
internal contacts to answer questions regarding environmental issues or
assistance in understanding environmental regulations. Include hotline
calls in total.  These may duplicate other activities below.  [Note: 
Where the data is available, if you make several contacts with or on
behalf of one business, it counts as one business assisted even if it
was for multiple issues. Count each “Confidential” or
“Anonymous” contact as a separate business in this column.]

ON-SITE VISITS

One-on-one meetings at the business's work site to answer questions
about environmental issues, assist with self audit activities, or
present information about environmental programs. Does not include
enforcement inspections.  [Effort = total number of site visits made.] 

REGULATORY APPLICABILITY

Any type of assistance provided to a business relating to rules or
permit/exemption applicability. This may include compliance
requirements, permit applications or questions, notification/reporting
forms, other regulatory determinations, or directing business owners or
managers to contacts for additional assistance.  

REGULATORY PUBLICATIONS/ DOCUMENTS DISTRIBUTED TO SMALL BUSINESS

The number of regulatory publications distributed directly or indirectly
(i.e., through trade associations, etc.) to small businesses.  Do not
count web distribution.	Tools Developed

	Copies Distributed

WORKSHOPS AND SEMINARS Workshops and seminars that were provided to
small businesses for the purpose of compliance assistance.  	Attendees

	Events

ADVOCACY 

Activities to advocate on behalf of small businesses; include inquiries
or investigation of complaints or disputes between a small business and
any government body related to environmental issues. Also included are
any activities advocating for small businesses in the rulemaking
process, such as writing letters to regulation agencies, attending
related hearings, and commenting on proposed rules.	Rules commented on:

	Businesses potentially impacted 

	Individual businesses assisted, through advocacy 

PROMOTIONAL ACTIVITIES

Provide information on promotional activities for the calendar year.
Spaces have been left open to add additional types of activities not
represented here.

Promotional activities are activities whose primary purpose is to
increase awareness of the program and its services. This can include
informational presentations, newsletters with contact information,
public service announcements, radio talk shows, news print, special
events, state fairs, or other forms of advertisement.

Promotional Activity	Number	Estimated Audience

	SBO	SBEAP	Dual Role	SBO	SBEAP	Dual Role

PUBLICATIONS AND NEWSLETTERS DISTRIBUTED

Publications created to increase the visibility of the organization. For
the "Number," provide the number of publications created; for the
"Estimated Audience," provide the number of publications distributed,
either in print or electronically.

SEMINARS, PRESENTATIONS, AND MEETINGS

Events created and/or attended to increase a program’s visibility and
understanding of what the program does for small businesses.

Radio Talk Shows

Other

Other

Other

Total Promotional Activities

WEB SITE ACTIVITY

Number of times your web site was accessed.

Web site “visits” or “views” are recorded every time a web page
is viewed. The terms used may differ slightly among web analytical
software packages.

Do not report “hits” as in previous reports, because this captures
the number of times images on that page were viewed rather than the
number of times the page itself was viewed. Do your best to capture the
numbers that represent activity for your SBO/SBEAP program pages,
through views or visits, however your software tracks the number. If you
are confused about what to count/track for web sites, please contact
Audrey Zelanko with the Small Business Environmental Home Page.

	Your Web Site Address	Number of Web Site Pages	Total Number of
Visits/Views

SBO only

	SBEAP only

	Dual (SBO/SBEAP)

	

Do you use other Social Media outlets?     	( Yes     ( No

If yes, which ones?   ( Facebook     ( LinkedIn     ( Twitter  ( Other 
________________________________     

OUTCOME MEASURES

Outcomes are measures that capture desired results, such as emission
reductions, cost savings, or even improvement of compliance rates or
changes in understanding among businesses assisted. 

Does your state measure outcomes?      ( Yes     (  No

If you answer “No”, but have other less quantitative outcomes to
highlight you can use the tables provided in section 10.

If you answer “Yes”, complete the table below as best you can based
on outcome data you collect. Only report outcomes achieved through
SBO/SBEAP efforts, as opposed to other pollution prevention or toxics
reductions programs.  

Compliance improvement rate can include things such as percent of
notification forms provided by SBEAP and returned to state/EPA; improved
test scores from before and to after training provided; average number
of illegal dumping instances eliminated; etc. You can report any similar
efforts that improved performance.

The number of facilities assisted/impacted should directly relate to the
results reported, whether the number that measured reductions/savings or
the number tested for compliance improvement rates.

EXAMPLE

Activity (what did you do): 

	Sector: 

	Media (air, water, waste, other): 

	Universe: 

	Response rate: 

	Metric (how do you measure results): 

	Results:

	Comments

	

Activity (what did you do): 

	Sector: 

	Media (air, water, waste, other): 

	Universe (who are you collecting information from): 

	Response rate: 

	Metric (how do you measure results): 

	Results:

	Comments:

	

Activity (what did you do): 

	Sector: 

	Media (air, water, waste, other): 

	Universe(who are you collecting information from): 

	Response rate: 

	Metric (how do you measure results): 

	Results:

	Comments

	

Activity (what did you do): 

	Sector: 

	Media (air, water, waste, other): 

	Universe(who are you collecting information from): 

	Response rate: 

	Metric (how do you measure results): 

	Results:

	Comments:

	

[Copy and paste empty tables if you have multiple efforts to summarize.]

OTHER PROGRAM HIGHLIGHTS

Include information about your program that you would like to highlight.
To help tell the story about the value of our programs, include enough
detail to address the following:

Provide descriptions of the most successful initiatives and activities
over the year (workshops, new partnerships, outreach activities).

Describe any successes over the year (awards, positive feedback, new
initiatives, success stories, etc.)

Describe specific issues that you resolved or found solutions to during
the year Is there anything that makes your program or services unique?

SBO

	SBEAP	 

Dual (SBO/SBEAP)	

CAP	 

Other	

YOU HAVE COMPLETED THE REPORT.  THANK YOU!

OMB No: 2060-0337

Approval Expires: xx/xx/xx

EPA Form 6500-03

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SBTCP Annual Reporting Form 		      Page   PAGE  1  of   NUMPAGES   11