Form 6500-03 State Small Business Stationary Source Technical and Env

ANNUAL REPORTING FORM – DRAFT

OMB Control No. 2060-0037

Exp. Date XXX XXXX

STATE SMALL BUSINESS STATIONARY SOURCE

TECHNICAL AND ENVIRONMENTAL COMPLIANCE

ASSISTANCE PROGRAM (SBTCP)

ANNUAL REPORTING FORM

FOR THE PERIOD January 01 TO December 31 (Each Calendar Year)

*** Completed forms are due by March 31 of each year ***

This is the Annual Reporting Form for the State Small Business Stationary Source Technical and Environmental Compliance Assistance Programs (SBTCPs) under the Clean Air Act (CAA) as amended in 1990. We are collecting objective information on each SBTCP. This report is not an evaluation of your program.

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 as the document title before continuing.

2. Please complete the electronic version of the Form. Do not answer questions by referring to attached documents or a previous SBTCP report.

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 section of this document. For future reports, you may need to revise the statistics 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.

5. Use the Tab key to move between entry fields. If you use another method to navigate the form the totals will not be accumulated accurately.

6. In the narrative section at the end of the Form you may cut and paste text from another file, however you will not be able to spell check the text after pasting. It is recommended that you check spelling and grammar prior to pasting into this document.

7. Appendix A is a pilot section that contains outcome-based measures which are new for many state programs. They are being tested to determine if they should be added to the standard survey section. We invite states to answer as many of these questions as they can so that the usefulness of these questions can be fully evaluated.

8. Once your form is complete please e-mail a copy of the document to Angela Suber [email protected].

9. Contact Angela Suber at 202 566-2827 if you have questions, or e-mail, [email protected]

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 SBAP, and the CAP, and ask them to complete applicable sections.

• However, one person should take responsibility for completing and submitting this Form (most likely the SBO).

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

PROGRAM INFORMATION

Provide the name of the State or Territory for which this report is being submitted.

     

	REPORTING FORM CONTACT
Name	     
Title	     
Agency/Organization	     
Address	     
City, State, Zip	     ,            
Telephone Number	(   )    -     X     
FAX Number	(   )    -    
E-mail address	     

BUDGET

Record the combined budget for your SBO, SBEAP, and CAP for calendar year. (If your budget is by fiscal year, please indicate the FY budget that is in effect as of 12/31.)

2005 Budget Total	$     
Sources	Title V Fees	105 Funds	General State Funds	Federal Grants		Other
Budget Change	Increase	Decrease	No Change

STAFFING

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

Total FTEs
SBO Staff #      	SBAP Staff #      

What is the status of your Compliance Advisory Panel (CAP)?

Status	Check if applicable
Do you have a CAP?	Yes No # Positions Vacant    
Active (holding meetings or conference calls)	Yes No N/A

OUTREACH AND TECHNICAL ASSISTANCE

Does your program offer air-only or multimedia assistance?

Multimedia is defined as providing any services for media beyond air.

air-only

multimedia

Please provide the requested data for each compliance assistance activity during the year. In the event that your program does not provide that service, please enter N/A.

Compliance assistance includes activities, tools, and technical assistance which 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 “Total Estimated Number of Businesses Assisted by this Effort” column is intended to count individual businesses for each assistance type. Thus the same business may be counted in multiple assistance categories. In contrast, question #8 asks for the overall total number of individual businesses assisted, which is not a simple summation of the third column. For example: A small business calls you with an air permitting question. To answer this question you have to make 4 additional phone calls, 3 e-mails, 1 permit determination and 1 mailing. To record this activity on this form you would:

• Add 5 phone calls (remember the initial call that started it all) to the amount of effort column for phone calls

• Add 1 to the total estimated number of businesses assisted by this effort column (note if you help this business again and make phone calls you would add those to the amount of effort column, but not to this column)

• Add 3 to the number of e-mails made in the effort column for emails

• Add 1 to the total estimated number of businesses assisted by this effort column (note if you help this business again and write e-mails you would add those to the amount of effort column, but not to this column)

• Add 1 to the air portion of the amount of effort column for permit determinations

• Add 1 to the total estimated number of businesses assisted by this effort column (note if you help this business again with other permit determinations you would add those to the amount of effort column, in the appropriate media, but not to this column)

• Add 1 to the mailings portion of the amount of effort column under # of mailings sent out

• Add 1 to the total estimated number of businesses assisted by this effort column (note if you help this business again and send out a document you would add those to the amount of effort column, but not to this column)

• And finally, you would add 1 to your answer for question 8 (only if this business had not been included in that count already)

If you find you are unable to put in a piece of data please not that in the narrative section at the end of the main survey.

Method of Assistance Provided	Amount of Effort	Total Estimated Number of Businesses Assisted by this Effort
1) 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. Not an inspection. In the “Amount of Effort” column, please put the total number of site visits made. In the “Total Estimated Number of Businesses Assisted by this Effort” column put the number of small businesses that were assisted by this effort (note: if you went to the same business site multiple times it still counts as one business assisted).		     
2) Phone Calls Made and Received Phone calls made to businesses, trade associations, federal offices, or the general public, as well as internal calls that answer questions about environmental issues. Phone calls received, either “hotline” or standard office phone that relate to assistance in understanding environmental regulations or questions about environmental issues. In the “Amount of Effort” column, please put the total number of calls made and received. In the “Total Estimated Number of Businesses Assisted by this Effort” column, put the number of small businesses that were assisted by this effort (note: if you made several calls to, or on behalf of one business, it still counts as one business assisted, even if it was for multiple issues). Each “Confidential” or “Anonymous” call will be counted as a separate business in this column.		     
3) E-Mails Sent and Received E-mail correspondence related to compliance assistance. In the “Amount of Effort” Column please put the total number of emails sent and received. In the “Total Estimated Number of Businesses Assisted by this Effort” column, put the number of small businesses that were assisted by this effort (note: if you sent/received several emails to, or on behalf of one business, it still counts as one business assisted, even if it was for multiple issues).		     
4) Permit and Licensing Determination Any type of assistance provided to a business relating specifically to permit and license determination, even if the determination is that the permit/license is not necessary. This may include compliance requirements, reviews, written permits, answering questions about permits, other environmental regulatory determinations, or directing business owners or managers to the correct office or web site for additional assistance. In the “Amount of Effort” column, please assign the individual determinations into the appropriate media. In the “Total Estimated Number of Businesses Assisted by this Effort” column put the number of small businesses that were assisted by this effort (note: if you made several determinations for and individual business it still counts as one business assisted).	Air: Water: Waste:	     
5) Face-to-Face Meetings Any face-to-face meeting held with a small business entity for the purpose of compliance assistance at any location other than the small business site. In the “Amount of Effort” column please put the total number of face-to-face meeting attended. In the “Total Estimated Number of Businesses Assisted by this Effort” column, put the number of small businesses that were assisted by this effort (note: if you attended several meetings with or concerning one business it still counts as one business assisted, even if it was for multiple issues).		     
6) Publications/Documents Distributed to Small Business The number of publications that were distributed directly to a small business. In the “Amount of Effort” Column please put the total number of different documents distributed in the first field and the actual number of copies distributed, not the number published, in the second field. In the “Total Estimated Number of Businesses Assisted by this Effort” column, put the number of small businesses that received documents.	Number of different mailings distributed       Total # of copies distributed	     
7) Workshops and Seminars Workshops and seminars that were provided to small businesses for the purpose of compliance assistance. In the “Amount of Effort” Column please put the number of workshops and seminars you provided in the first field and the people attending workshops/seminars where your organization presented or had an informational booth in the second field. In the “Total Estimated Number of Businesses Assisted by this Effort” column, put the number of small businesses that were assisted by this effort (note: if a business had several people representing it and/or attended several of your workshops/seminars it still counts as one business assisted, even if it was for multiple issues).	Number of workshops/seminars provided       Total # of attendees	     

8) What is the estimated total number of individual small business your program assisted over the course of the year? This is not a summation of totals from the table above. For example, if a small business needed permit help and that generated five phone calls, a site visit, three emails, and a mailing it would still count as one small businesses assisted.

________________

Please provide information on Marketing 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 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
9) Publications and Newsletters Distributed The number of publications mailed or distributed for the purpose of increasing the visibility of the organization. Please provide the number of documents distributed, not the number published	     	     
10) Seminars, Presentations, and Meetings attended to increase a program’s visibility and understanding of what the program does for small businesses.	     	     
11) Radio Talk Shows	     	     
12)      	     	     
13)      	     	     
14)      	     	     
15)      	     	     
Total Promotional Activities		0

Web Site Activity: How many times did people access your web site to get information on your environmental assistance program?

Web site hits are contacts made by outside organizations or the general public to obtain information about your environmental assistance program, regulations, or guidance through access to your web site.

	Your Web Site Address	Number of Web Site Pages	Total Number of Hits
16)	     	     	     
17)	     	     	     

Please include information about your program that you would like to highlight, significant accomplishments, awards, actions taken to move to multimedia, changes in annual budget or FTE’s, etc. Positive outcomes and case studies are especially appreciated!

     

Appendix A – Pilot Measures

This section contains pilot measures that may be adopted in the future. We encourage you to answer them as completely as possible. However, providing this data is voluntary.

This section asks for data on a yes-neutral-no scale. If you collect this data in ranges (e.g. 1-10, poor, fair, good or excellent) you can translate your data by dividing it into three groups with the upper portion being “yes”, the lower portion being “no” and the middle section (in the event of an odd number of choices on the scale) being “neutral.”

	Yes	Neutral	No	number responded out of the number surveyed
1) Number of small businesses indicating improved understanding of regulatory requirements				___ out of ___
2) Number of small businesses that made a change after receiving assistance from the program				___ out of ___
3) Number of small businesses indicating satisfaction with the program service				___ out of ___
4) Number of small businesses indicating that the services were provided in a timely fashion				___ out of ___
5) Number of small businesses indicating that they would use the program’s services again				___ out of ___
6) Number of small businesses indicating they would recommend the program’s services to other businesses				___ out of ___
7) Number of small businesses indicating they had an increased understanding of available environmental resources				___ out of ___
8) Number of small businesses indicating they had an increased awareness of their facility’s air emissions				___ out of ___
9) Number of small businesses indicating a reduction in emissions or waste due to program assistance				___ out of ___
10) Number of small businesses indicating a reduction in toxic emissions due to program assistance				___ out of ___

11) How many permit applications, licensing registrations and permit applications were submitted by small businesses which your program assisted? This includes all permits that your program provided assistance for, even if your program did not fill the permit for out for the business. Assign the individual applications/registrations into the appropriate media.

Air Water Waste

12) What is the estimated total number of individual small government entities your program assisted over the course of the year? For example, if a county agency needed help and that generated five phone calls, a site visit, three emails, and a mailing it would still count as one entity assisted.	________________
13) How many violations did your program identify and help correct through your compliance assistances activities?

Comments

Please let us know what you thought of these “pilot questions” also please mention any clarifications you would like to make on your answers to the questions in this appendix.

Burden Statement

Public reporting and recordkeeping burden for this collection is estimated to average 80 hours state responder. This includes the time for reviewing instructions, gathering information, searching data sources, completing and reviewing the collection of information, transmitting the information, and maintaining the information. 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 Director, OEI, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Avenue, NW, Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk Officer for EPA. Include the EPA ICR number (1748.05) and OMB control number (2060-0337) in any correspondence.

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EPA Form Number 6500-03