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Urban Environmental Program in New England

Grant Management Forms & Reports

Forms & Reports
  • ACH Vendor/Miscellaneous Payment Enrollment Form (SF3881) (PDF) (2 pp, 64 K) (DOC) (1 pg, 48 K)
  • U.S. EPA Payment Request (EPA 190-F-04-001) (PDF) (1 pg, 26 K) (DOC) (1 pg, 101 K)
  • Quarterly Report (PDF) (1 pg, 184 K) (DOC) (1 pg, 29 K)
  • Final Report (PDF) (4 pp, 69 K) (DOC) (4 pp, 34 K)
  • Federal Financial Report (SF 425) (PDF) (1 pg, 90 K) (XLS) (1 pg, 42 K)
  • MBE/WBE Report (EPA 5700-52A) (PDF) (5 pp, 50 K) (DOC) (3 pp, 78 K)
  • Lobbying and Litigation Certificate (EPA 5700-53) (PDF) (1 pg, 30 K) (DOC) (3 pp, 63 K)

You will need Adobe Reader to view some of the files on this page. See EPA's PDF page to learn more about PDF, and for a link to the free Acrobat Reader.

  1. Submit ACH Vendor Enrollment form to Las Vegas Finance Center. Details >
  2. Submit EPA Payment Requests to Las Vegas Finance Center. Details >
  3. Submit Quarterly Reports to your EPA Project Officer. Details >
  4. Submit Final Report to your EPA Project Officer. Details >
  5. Submit Federal Financial Report (FFR) form to Las Vegas Finance Center. Details >
  6. Submit MBE/WBE Report to EPA Region 1. Details >
  7. Submit Lobbying and Litigation form to EPA Region 1. Details >

1. Submit ACH Vendor/Miscellaneous Payment Enrollment Form (SF3881) to Las Vegas Finance Center

graphic showing forms sent to Las Vegas center

Organizations are required to have their banking data on file with the Las Vegas Finance Center before a Payment Request can be processed. Electronic Fund Transfer (EFT) is a safe and simple method of receiving grant payments. Click here for more information.

  • ACH Vendor/Miscellaneous Payment Enrollment form (SF3881):
    PDF Version (2 pp, 64 K) | Microsoft Word Version (1 pg, 48 K)
    (The PDF form is not interactive; you must print it and fill it out manually.)
  • Please fax the completed form(s) to (702) 798-2423 or mail to LVFC address
    US EPA
    LVFC
    PO Box 98515
    Las Vegas, NV 89193-8515
  • Questions regarding the ACH Vendor/Miscellaneous Payment Enrollment form (SF3881) may be directed to:
    Sharen Rheinhardt (rheinhardt.sharen@epa.gov)
    Fax (702) 798-2423
    Phone (702) 798-2471

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2. Submit EPA Payment Request Form (EPA 190-F-04-001) to Las Vegas Finance Center

graphic showing forms sent to Las Vegas center

After you have returned one signed copy of your grant agreement to EPA Region 1, you may request payment for grant-related expenses as needed, using the form below. The LVFC will review each request. When the request is approved for payment, EPA will electronically transfer the funds through the U.S. Department of Treasury and the Federal Reserve for credit to the recipient's account at their designated financial institution within 3 to 5 business days following receipt and approval of the request. If the entire request or a portion of the request is rejected, the recipient will be notified by the LVFC no later than 1 workday following receipt of the request.

  • U.S. EPA Payment Request (EPA190-F-04-001) form:
    PDF Version (1 pg, 26 K) | Microsoft Word Version (1 pg, 101 K)
    (The PDF form is not interactive; you must print it and fill it out manually.)
  • Please fax the completed form(s) to (702) 798-2423 or mail to LVFC address
    US EPA
    LVFC
    PO Box 98515
    Las Vegas, NV 89193-8515
  • Questions regarding the Payment Request Form (EPA Form 190-F-04-001) may be directed to:
    Sharen Rheinhardt (rheinhardt.sharen@epa.gov)
    Fax (702) 798-2423
    Phone (702) 798-2471

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3. Submit Quarterly Reports to your EPA Project Officer

graphic showing forms sent to Las Vegas center

Progress reports must be sent every three months during your project period. The first report is due three months from the project's start date.

  • Quarterly Report Format
    PDF Version (1 pg, 184 K) | Microsoft Word Version (1 pg, 29 K)
  • Quarterly Reports can be submitted to your EPA Project Officer via mail, email, or fax.
    US EPA, Region 1
    Attn: (Insert Project Officer's Name)
    5 Post Office Square, Suite 100 (OARM 16-2)
    Boston, MA 02109-3912
  • Questions regarding the Quarterly Report should be directed to your EPA Project Officer.

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4. Submit Final Report to your EPA Project Officer

graphic showing forms sent to Las Vegas center

A draft version of the report should be submitted to your EPA Project Officer within 30 calendar days after the project end date. The EPA Project Officer will respond with suggested edits as necessary. The final version of the report is due to the EPA Project Officer within 90 calendar days after the project end date.

  • Final Report Format
    PDF Version (4 pp, 69 K) | Microsoft Word Version (4 pp, 34 K)
  • Draft Final Reports can be submitted to your EPA Project Officer via mail or email. Two copies of the final version must be submitted via mail and should include any attachments. Attachments may include photos, meeting agendas, outreach materials, press coverage, etc.
    US EPA, Region 1
    Attn: (Insert Project Officer's Name)
    5 Post Office Square, Suite 100 (OARM 16-2)
    Boston, MA 02109-3912
  • Questions regarding the Final Report should be directed to your EPA Project Officer

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5. Submit Federal Financial Report (SF 425) to the Las Vegas Finance Center

graphic showing forms sent to Las Vegas center

A final Financial Status Report is due within 90 days of the expiration of your grant.

  • Federal Financial Report (SF 425):
    PDF Version (1 pg, 90 K) | Excel Version (1 pg, 42 K)
  • Please fax the completed form(s) to (702) 798-2423 or mail to LVFC address
    US EPA
    LVFC
    PO Box 98515
    Las Vegas, NV 89193-8515
  • Questions regarding the Payment Request Form (SF 425) may be directed to:
    Sharen Rheinhardt (rheinhardt.sharen@epa.gov)
    Fax (702) 798-2423
    Phone (702) 798-2471

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6. Submit Minority/Women-Owned Business Report (EPA 5700-52A) to EPA Region 1 Grants Office

graphic showing forms sent to Las Vegas center

This report must be submitted to the Grants Management Office by October 30 of each year. Refer to the terms and conditions of your grant for this requirement.

  • Minority Business Enterprises/Women-owned Business Enterprises Utilization Report (EPA 5700-52A):
    PDF Version (5 pp, 289 K) | Microsoft Word Version (5 pp, 78 K)
    (The PDF form is not interactive; you must print it and fill it out manually.)
  • Submit the completed form(s) to Larry Wells via mail.
    US EPA, Region 1
    Attn: Larry Wells
    5 Post Office Square, Suite 100 (OARM 16-2)
    Boston, MA 02109-3912
  • Questions regarding the Minority Business Enterprises/Women-owned Business Enterprises Utilization Report (EPA 5700-52A) may be directed to:
    Larry Wells (wells.larry@epa.gov)
    Phone (617) 918-1836

Need More Information?
The following items can be accessed at EPA's Small Business Programs Web Site:

  • Disadvantaged Business Enterprise (DBE) Rule
  • DBE Manual
  • DBE Program Fact Sheets
    • Overview of EPA’s DBE Rule and Program
    • Fair Share Objectives (MBE/WBE Goals);
    • Good Faith Efforts (outreach to MBE, WBE, and other DBE)
    • MBE/WBE Reporting under the DBE Rule
    • MBE/WBE Certification

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7. Submit Lobbying and Litigation certificate (EPA 5700-53) to EPA Region 1 Grants Office

graphic showing forms sent to Las Vegas center

This certification must be signed by the head of your organization and submitted to the Grants Management Office at the EPA Region 1 address within 90 days after the end of the project period.

  • Lobbying and Litigation form (EPA 5700-53):
    PDF Version (1 pg, 30 K) | Microsoft Word Version (1 pg, 63 K)
    (The PDF form is not interactive; you must print it and fill it out manually.)
  • Submit the completed form(s) to your grant specialist via mail.
    US EPA, Region 1
    Attn: (Insert Grant Specialist's Name)
    5 Post Office Square, Suite 100 (OARM 16-2)
    Boston, MA 02109-3912
  • Questions regarding the Lobbying and Litigation form (EPA 5700-53) may be directed to your Grant Specialist

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