4700-4 Preaward Compliance Review Report for All Applicants and

Approved By OMB: No. 2030-0020 Expires 06-.30-2017
U.S. ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460

Preaward Compliance Review Report for
All Applicants and Recipients Requesting EPA Financial Assistance

I.

Note: Read instructions on other side before completing form.
Applicant/Recipient (Name, Address, State, Zip Code).

II.

Is the applicant currently receiving EPA assistance?

III.

List all civil rights lawsuits and administrative complaints pending against the applicant/recipient that allege discrimination based on race,
color, national origin, sex, age, or disability. (Do not include employment complaints not covered by 40 C.F.R. Parts 5 and 7. See
instructions on reverse side.)

IV.

List all civil rights lawsuits and administrative complaints decided against the applicant/recipient within the last year that allege
discrimination based on race, color, national origin, sex, age, or disability and enclose a copy of all decisions. Please describe all corrective
action taken. (Do not include employment complaints not covered by 40 C.F.R. Parts 5 and 7. See instructions on reverse side.)

V.

List all civil rights compliance reviews of the applicant/recipient conducted by any agency within the last two years and enclose a copy of the
review and any decisions, orders, or agreements based on the review. Please describe any corrective action taken. (40 C.F.R. § 7.80(c)(3))

VI.

Is the applicant requesting EPA assistance for new construction? If no, proceed to VII; if yes, answer (a) and/or (b) below.

Yes

VII.

DUNS No.

No

a. If the grant is for new construction, will all new facilities or alterations to existing facilities be designed and constructed to be readily
No
Yes
accessible to and usable by persons with disabilities? If yes, proceed to VII; if no, proceed to VI(b).
b. If the grant is for new construction and the new facilities or alterations to existing facilities will not be readily accessible to and usable by
Yes
No
persons with disabilities, explain how a regulatory exception (40 C.F.R. § 7.70) applies.
Does the applicant/recipient provide initial and continuing notice that it does not discriminate on the basis of race, color, national origin, sex,
age, or disability in its programs or activities? (40 C.F.R. § 5.140 and § 7.95)
Yes
No

Yes
No
a. Do the methods of notice accommodate those with impaired vision or hearing?
b. Is the notice posted in a prominent place in the applicant’s offices or facilities or, for education programs and activities, in appropriate
No
Yes
periodicals and other written communications?
c. Does the notice identify a designated civil rights coordinator?
Yes
No
VIII.

Does the applicant/recipient maintain demographic data on the race, color, national origin, sex, age, or handicap of the population it serves?
(40 C.F.R. § 7.85(a))

IX.

Does the applicant/recipient have a policy/procedure for providing access to services for persons with limited English proficiency?
(40 C.F.R. Part 7, E.O. 13166)

X.

If the applicant/recipient is an education program or activity, or has 15 or more employees, has it designated an employee to coordinate its
compliance with 40 C.F.R. Parts 5 and 7? Provide the name, title, position, mailing address, e-mail address, fax number, and telephone
number of the designated coordinator.

XI.

If the applicant/recipient is an education program or activity, or has 15 or more employees, has it adopted grievance procedures that assure
the prompt and fair resolution of complaints that allege a violation of 40 C.F.R. Parts 5 and 7? Provide a legal citation or Internet address
for, or a copy of, the procedures.
For the Applicant/Recipient

I certify that the statements I have made on this form and all attachments thereto are true, accurate and complete. I acknowledge that any knowingly
false or misleading statement may be punishable by fine or imprisonment or both under applicable law. I assure that I will fully comply with all
applicable civil rights statutes and EPA regulations.
A. Signature of Authorized Official

B. Title of Authorized Official

C. Date

For the U.S. Environmental Protection Agency
I have reviewed the information provided by the applicant/recipient and hereby certify that the applicant/recipient has submitted all preaward
compliance information required by 40 C.F.R. Parts 5 and 7; that based on the information submitted, this application satisfies the preaward provisions
of 40 C.F.R. Parts 5 and 7; and that the applicant has given assurance that it will fully comply with all applicable civil rights statutes and EPA
regulations.
A.

Signature of Authorized EPA Official

B. Title of Authorized EPA Official

See * note on reverse side.
EPA Form 4700-4 (Rev. 06/2014). Previous editions are obsolete.

C. Date

Instructions for EPA FORM 4700-4 (Rev. 06/2014)
General

Items

Recipients of Federal financial assistance from the U.S.
Environmental Protection Agency must comply with the following
statutes and regulations.

“Applicant” means any entity that files an application or unsolicited
proposal or otherwise requests EPA assistance. 40 C.F.R. §§ 5.105,
7.25.

Title VI of the Civil Rights Acts of 1964 provides that no person in
the United States shall, on the grounds of race, color, or national
origin, be excluded from participation in, be denied the benefits of, or
be subjected to discrimination under any program or activity
receiving Federal financial assistance. The Act goes on to explain
that the statute shall not be construed to authorize action with respect
to any employment practice of any employer, employment agency, or
labor organization (except where the primary objective of the Federal
financial assistance is to provide employment).

“Recipient” means any entity, other than applicant, which will actually
receive EPA assistance. 40 C.F.R. §§ 5.105, 7.25.

Section 13 of the 1972 Amendments to the Federal Water Pollution
Control Act provides that no person in the United States shall on the
ground of sex, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under the Federal Water
Pollution Control Act, as amended. Employment discrimination on
the basis of sex is prohibited in all such programs or activities.
Section 504 of the Rehabilitation Act of 1973 provides that no
otherwise qualified individual with a disability in the United States
shall solely by reason of disability be excluded from participation in,
be denied the benefits of, or be subjected to discrimination under any
program or activity receiving Federal financial assistance.
Employment discrimination on the basis of disability is prohibited in
all such programs or activities.
The Age Discrimination Act of 1975 provides that no person on the
basis of age shall be excluded from participation under any program
or activity receiving Federal financial assistance. Employment
discrimination is not covered. Age discrimination in employment is
prohibited by the Age Discrimination in Employment Act
administered by the Equal Employment Opportunity Commission.
Title IX of the Education Amendments of 1972 provides that no
person in the United States on the basis of sex shall be excluded from
participation in, be denied the benefits of, or be subjected to
discrimination under any education program or activity receiving
Federal financial assistance. Employment discrimination on the basis
of sex is prohibited in all such education programs or activities.
Note: an education program or activity is not limited to only those
conducted by a formal institution.
40 C.F.R. Part 5 implements Title IX of the Education Amendments
of 1972.
40 C.F.R. Part 7 implements Title VI of the Civil Rights Act of 1964,
Section 13 of the 1972 Amendments to the Federal Water Pollution
Control Act, and Section 504 of The Rehabilitation Act of 1973.
The Executive Order 13166 (E.O. 13166) entitled; "Improving
Access to Services for Persons with Limited English Proficiency"
requires Federal agencies work to ensure that recipients of Federal
financial assistance provide meaningful access to their LEP
applicants and beneficiaries.

“Civil rights lawsuits and administrative complaints” means any
lawsuit or administrative complaint alleging discrimination on the
basis of race, color, national origin, sex, age, or disability pending or
decided against the applicant and/or entity which actually benefits
from the grant, but excluding employment complaints not covered by
40 C.F.R. Parts 5 and 7. For example, if a city is the named applicant
but the grant will actually benefit the Department of Sewage, civil
rights lawsuits involving both the city and the Department of Sewage
should be listed.
“Civil rights compliance review” means any review assessing the
applicant’s and/or recipient’s compliance with laws prohibiting
discrimination on the basis of race, color, national origin, sex, age, or
disability.
Submit this form with the original and required copies of applications,
requests for extensions, requests for increase of funds, etc. Updates of
information are all that are required after the initial application
submission.
If any item is not relevant to the project for which assistance is
requested, write “NA” for “Not Applicable.”
In the event applicant is uncertain about how to answer any questions,
EPA program officials should be contacted for clarification.
* Note: Signature appears in the Approval Section of the EPA
Comprehensive Administrative Review For Grants/Cooperative
Agreements & Continuation/Supplemental Awards form.
“Burden Disclosure Statement”
EPA estimates public reporting burden for the preparation of this form
to average 30 minutes per response. This estimate includes the time
for reviewing instructions, gathering and maintaining the data needed
and completing and reviewing the form. Send comments regarding the
burden estimate, including suggestions for reducing this burden, to
U.S. EPA, Attn: Collection Strategies Division (MC 2822T), Office of
Information Collection, 1200 Pennsylvania Ave., NW, Washington,
D.C. 20460; and to the Office of Information and Regulatory Affairs,
Office of Management and Budget, Washington, D.C. 20503.
The information on this form is required to enable the U.S.
Environmental Protection Agency to determine whether applicants and
prospective recipients are developing projects, programs and activities
on a nondiscriminatory basis as required by the above statutes and
regulations.