5900-407 Technicial Certification

OMB Control Number: 2060-0256

Expiration Date: MM/DD/YYYY

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY

Section 608 Technician Certification Report

This form is provided as a courtesy: use of this form is optional. You can provide the information in a different format. Reports are due twice a year, by January 30 and July 30.

Date of Submission:      
Reporting Period Covered: January 1 – June 30 July 1 – December 31 Year      
Name of Program:      
Address:      
Contact Name:      
Contact Phone Number:      
Contact Email:      
Section of Test*	Technicians Tested		Technicians Passed/Certified	Percent Passed/Certified
Core	     		     	     %
Type I	     		     	     %
Type II	     		     	     %
Type III	     		     	     %

*Please report the sections of the Universal certification separately under Core, Type I, II, and III.

	Technicians Certified (Any Type)
Total number of technicians certified during this reporting period*	     
Total number of technicians certified during all periods since program approval*	     

* When calculating TOTALS, please count each technician only once, regardless of how many types of tests/certifications he/she has taken/received.

Please submit reports electronically to: [email protected].

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The number and expiration date are displayed in the upper right corner of the form. The public reporting and recordkeeping burden for this collection of information is estimated to average 2 hours per year. 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 Avenue NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

EPA Form Number: 5900-407