Form 6500-03 Annual Reporting Form

STATE SMALL BUSINESS STATIONARY SOURCE

TECHNICAL AND ENVIRONMENTAL COMPLIANCE

ASSISTANCE PROGRAM (SBTCP)

ANNUAL REPORTING FORM

FOR THE PERIOD January 01, 2012 TO December 31, 2012

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

*** Completed forms are due by March 31, 2013***

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.

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 as the document title before continuing.

2. Please complete the electronic version of this 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 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. Use the Tab key to move between entry fields. Check boxes will automatically fill-in when clicked. Fields will only accept appropriate information (e.g., number fields will only accept numbers).

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 Angela Suber, [email protected].

8. If you have questions, contact Angela Suber at 202 566-2827 or [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 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.

1. PROGRAM INFORMATION

Name of State or Territory
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 __________________________________

2. 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:

3. 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

4. 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)

5. 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)

6. 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

7. PROMOTIONAL ACTIVITIES

P rovide 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

8. 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 ___________________________________

9. 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):	workshop on 6h rule
Sector:	autobody
Media (air, water, waste, other):	air
Universe:	100 participants at the workshop
Response rate:	75%
Metric (how do you measure results):	survey after workshop
Results:	90% improved understanding; 75% understand fully
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.]

10. 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!

SBTCP Annual Reporting Form Page 19 of 19