5770-9 EPA Completion of Studies Notice

OMB Control No. 2030-0020
Approval expires 06/30/2017

U.S. ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460
COMPLETION OF STUDIES NOTICE
DATE OF THIS NOTICE:

FELLOWSHIP NUMBER

STUDIES COMPLETED

TYPE OF FELLOWSHIP

Special Status:
TO:

LAS VEGAS FINANCE CENTER
US ENVIRONMENTAL PROTECTION AGENCY
4220 S. MARYLAND PARKWAY, BUILDING C, ROOM 503
LAS VEGAS, NV 89119
INSTRUCTIONS: This form should be completed immediately after studies are completed

NAME OF FELLOW

INSTITUTION

Your Fellowship ends on the date indicated above. To complete our files, please provide the following
information and two reprints of any publication of work done under the fellowship, when available.
MAILING ADDRESS AFTER COMPLETION OF FELLOWSHIP (Future address changes appreciated)

DEGREE SOUGHT (Ph.D., M.S.,
None)

DATE RECEIVED OR EXPECTED

REMARKS (Provide any constructive criticism or advice from you and your sponsor that would enable us to improve the operation of the EPA Fellowship
program. Use an additional sheet if necessary.)

CERTIFICATION
This is to certify that the individual named above completed the fellowship activities at the above named institution.
DATE

EPA Form 5770-9 (7-73)

SIGNATURE OF SPONSOR OR AUTHORIZED OFFICIAL

TITLE

REPLACES FORM FWQA 190-1 (9-70) WHICH IS OBSOLETE AND FORM PHS 416-7 WHICH WILL NOT BE USED.

The public reporting and recordkeeping burden for this collection of information is estimated to average 1 hour 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.