5900-02 CTAC, Certification of Truth, Accuracy, and Completeness

OMB No. 2060-0336, Approval Expires 04/30/2012

Federal Operating Permit Program (40 CFR Part 71)
CERTIFICATION OF TRUTH, ACCURACY, AND COMPLETENESS (CTAC)
This form must be completed, signed by the “Responsible Official” designated for the facility or
emission unit, and sent with each submission of documents (i.e., application forms, updates to
applications, reports, or any information required by a part 71 permit).
A. Responsible Official
Name: (Last) _________________________ (First) _______________________ (MI) ____
Title ___________________________________________________
Street or P.O. Box ________________________________________
City ___________________________________ State _____
Telephone (____) _____ - _________ Ext. _______

ZIP _________ - _____

Facsimile (____) _____ - __________

B. Certification of Truth, Accuracy and Completeness (to be signed by the responsible
official)
I certify under penalty of law, based on information and belief formed after reasonable inquiry, the
statements and information contained in these documents are true, accurate and complete.
Name (signed) _____________________________________
Name (typed) _____________________________________ Date: _____ /_____ /_________

EPA Form 5900-02

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INSTRUCTIONS FOR CTAC
CERTIFICATION OF TRUTH, ACURACY, and COMPLETENESS
This form is for the responsible official to certify that submitted documents (i.e., permit applications,
updates to application, reports, and any other information required to be submitted as a condition of a
permit) are true, accurate, and complete.
This form should be completed and submitted with each set of documents sent to the permitting
authority. It may be used at time of initial application, at each step of a phased application submittal,
for application updates, as well as to accompany routine submittals required as a term or condition of
a permit.
Section A - Title V permit applications must be signed by a responsible official. The definition of
responsible official can be found at ' 70.2.
Section B - The responsible official must sign and date the certification of truth, accuracy and
completeness. This should be done after all application forms are complete and the responsible
official has reviewed the information. Normally this would be the last form completed before the
package of forms is mailed to the permitting authority.

EPA Form 5900-02