Form 6100-056 Alternative Phase 2 Compliance Deadline Request

Attachment 1 – State NPDES eRule Phase 2 Alternative Phase 2 Compliance Deadline Request

	STATE NPDES ERULE PHASE 2 ALTERNATIVE PHASE 2 COMPLIANCE DEADLINE REQUEST EPA FORM 6100-056 FORM OMB APPROVED 2020-0037 EXP. MM/YYYY	FOR EPA USE ONLY
		[Date Received]

Director Information

Director Email Address	Director Telephone Number

ALTERNATIVE PHASE 2 COMPLIANCE DEADLINE REQUEST SUPPORTING INFORMATION

INSTRUCTIONS: Identify each general permit, program report, and/or related data elements covered by the request and the corresponding alternative Phase 2 compliance deadline(s).

Provide a rationale for the delay and enough details (e.g., tasks, milestones, roles and responsibilities, necessary resources) to clearly describe how the program will successfully implement electronic reporting for general permit, program report, and/or related data element covered by the request.

If the request covers some but not all facilities subject to the general permit or program report requirement use this form to identify each facility covered by the request and the corresponding alternative Phase 2 compliance deadline(s).

(Attach additional pages if needed)

SIGNATURE

SCAN TO PDF AND RETURN COMPLETED APPLICATION TO: [email protected]	Director Printed Name
	Signature	Date

OMB Burden Statement: This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2020-NEW). Responses to this collection of information are mandatory (40 CFR 127). 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 public reporting and recordkeeping burden for this collection of information is estimated to be 16 hours per response. Send comments on the Agency’s need this formation, 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, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 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.