Form 4700-4 Pre-award Compliance Review for EPA Financial Assistance

OMB Control No. 2030-0020
Approval expires MM/DD/YYYY

Preaward Compliance Review Report for
All Applicants and Recipients Requesting EPA Financial Assistance
Note: Read Instructions before completing form.

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2030-0020). Responses to this collection of information
are required to obtain an assistance agreement (40 CFR Part 30, 40 CFR Part 31, and 40 CFR Part 33 for awards made prior to December 26, 2014, and 2 CFR 200, 2 CFR 1500, and 40 CFR
Part 33 for awards made after December 26, 2014). 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 0.5 hours 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 to the Regulatory Support Division Director, 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.

I. A. Applicant/Recipient (Name, Address, City, State, Zip Code)
Name:
Address:
City:
State:

Zip Code:

B. Unique Entity Identifier (UEI):
C. Applicant/Recipient Point of Contact
Phone:

Name:

Email:

Title:
II.

Yes

Is the applicant currently receiving EPA Assistance?

No

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

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

V.
List all civil rights compliance reviews of the applicant/recipient conducted under federal nondiscrimination laws by any federal 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

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
accessible to and usable by persons with disabilities? If yes, proceed to VII; if no, proceed to VI(b).
Yes

No

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 persons with disabilities, explain how a regulatory exception (40 C.F.R. 7.70) applies.

VII.

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 program or activities? (40 C.F.R 5.140 and 7.95)

Yes

No

a. Do the methods of notice accommodate those with impaired vision or hearing?

Yes

No

b. Is the notice posted in a prominent place on the applicant's/recipient's website, in the offices or facilities or,
for education programs and activities, in appropriate periodicals and other written communications?

Yes

No

c. Does the notice identify a designated civil rights coordinator?

Yes

No

EPA Form 4700-4

VII.

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

Yes

No

VIII.

Does the applicant/recipient have a policy/procedure for providing meaningful access to services for persons
with limited English proficiency? (Title VI, 40 C.F.R. Part 7, Lau v Nichols 414 U.S. 563 (1974))

Yes

No

X.

If the applicant 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 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 applicant's/
recipient's website 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 Official

C. Date

Instructions for EPA FORM 4700-4 (Rev. 04/2021)
General. Recipients of Federal financial assistance from the U.S. Environmental Protection Agency must comply with the following statutes and
regulations.
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). 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.
Items “Applicant” means any entity that files an application or unsolicited proposal or otherwise requests EPA assistance. 40 C.F.R. §§ 5.105, 7.25.
“Recipient” means any State or its political subdivision, any instrumentality of a State or its political subdivision, any public or private agency,
institution, organizations, or other entity, or any person to which Federal financial assistance is extended directly or through another recipient,
including any successor, assignee, or transferee of a recipient, but excluding the ultimate beneficiary of the assistance. 40 C.F.R. §§ 5.105, 7.25.
“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 federal agency-initiated investigation of a particular aspect of the applicant's and/or recipient's programs or activities to determine
compliance with the federal non-discrimination laws. 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.