5700-54 Key Contacts Form

Form Approved OMB No:2030-0020

KEY CONTACTS FORM
Authorized Representative: Original awards and amendments will be sent to this individual for
review and acceptance, unless otherwise indicated.
Name:
______________________________________________________________
Title:
______________________________________________________________
Complete Address: ______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________

Payee: Individual authorized to accept payments.
Name:
______________________________________________________________
Title:
______________________________________________________________
Mail Address:
______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________

Administrative Contact: Individual from Sponsored Program Office to contact concerning
administrative matters (i.e., indirect cost rate computation, rebudgeting requests etc.)
Name:
______________________________________________________________
Title:
______________________________________________________________
Mailing Address:
______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________
FAX Number: ______________________________________________________________
E-Mail Address:
______________________________________________________________

Principal Investigator: Individual responsible for the technical completion of the proposed work.
Name:
Title:
Mailing Address:

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________
FAX Number: ______________________________________________________________
E-Mail Address:
______________________________________________________________
Web URL:
______________________________________________________________

EPA Form 5700-54 (Rev 7-2009)

ADDITIONAL KEY CONTACTS

(Use as many sheets as needed)

Major Co-Investigators: Individual responsible for the completion of major portions of the proposed
work.
Name:
Title:
Mailing Address:

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________
FAX Number: ______________________________________________________________
E-Mail Address:
______________________________________________________________
Web URL:
______________________________________________________________

Major Co-Investigator: Individual responsible for the completion of major portions of the proposed
work.
Name:
Title:
Mailing Address:

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________
FAX Number: ______________________________________________________________
E-Mail Address:
______________________________________________________________
Web URL:
______________________________________________________________

Major Co-Investigator: Individual responsible for the completion of major portions of the proposed
work.
Name:
Title:
Mailing Address:

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________
FAX Number: ______________________________________________________________
E-Mail Address:
______________________________________________________________
Web URL:
______________________________________________________________

Major Co-Investigator: Individual responsible for the completion of major portions of the proposed
work.
Name:
Title:
Mailing Address:

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Phone Number:
______________________________________________________________
FAX Number: ______________________________________________________________
E-Mail Address:
______________________________________________________________
Web URL:
______________________________________________________________
EPA Form 5700-54 (Rev 7-2009)

Paperwork Reduction Act Burden Statement
The public reporting and recordkeeping burden for
this collection of information is estimated to
average 30 minutes 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.
EPA Form 5700-54 (Rev 7-2009)