ࡱ> \^[ @ +bjbjqq KR#BBBBBBB$|$~aaa5 ($$%R'nL$Ba]aaaL$BBa$aBBaBBr Pwq,w$0$Y(Y(f$,BBBBY(B4aaaaaaaL$L$$ United States Environmental Protection Agency Washington, DC 20460 Preaward Compliance Review Report For All Applicants Requesting Federal Financial Assistance FORM Approved OMB No. 2090-0014 Note: Read instructions on reverse side before completing form.I. A. Applicant (Name, City, State) B. Recipient (Name, City, State)C. EPA Project No. II. Brief description of proposed project, program or activity. III. Are any civil rights lawsuits or complaints pending against applicant and/or recipient? If "Yes," list those complaints and the disposition of each complaint.  ( Yes ( No IV. Have any civil rights compliance reviews of the applicant and/or recipient been conducted by any Federal agency during the two years prior to this application for activities which would receive EPA assistance? If "Yes," list those compliance reviews and status of each review.  ( Yes ( No V. Is any other Federal financial assistance being applied for or is any other Federal financial assistance being applied to any portion of this project, program or activity? If "Yes," list the other Federal Agency(s), describe the associated work and the dollar amount of assistance.  ( Yes ( No VI. If entire community under the applicant's jurisdiction is not served under the existing facilities/services, or will not be served under the proposed plan, give reasons why. VII. Population CharacteristicsNumber of People1.A. Population of Entire Service Area B. Minority Population of Entire Service Area2.A. Population Currently Being Served B. Minority Population Currently Being Served3.A. Population to be Served by Project, Program or Activity B. Minority Population to be Served by Project, Program or Activity4.A. Population to Remain Without Service B. Minority Population to Remain Without ServiceVIII. Will all new facilities or alterations to existing facilities financed by these funds be designed and constructed to be readily accessible to and usable by handicapped persons? If "No," explain how a regulatory exception (40 CFR 7.70) applies.  ( Yes ( No IX. Give the schedule for future projects, programs or activities (or of future plans), by which service will be provided to all beneficiaries within applicant's jurisdiction. If there is no schedule, explain why. X. 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. A. Signature of Authorized Official B. Title of Authorized OfficialC. DateFor the U.S. Environmental Protection Agency ( Approved ( DisapprovedAuthorized EPA OfficialDate EPA Form 4700-4 (Rev. 1/90) Previous editions are obsolete. Instructions General Recipients of Federal financial assistance from the U.S. Environmental Protection Agency must comply with the following statutes. Title VI of the Civil Rights Act 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 title 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 handicapped individual shall solely by reason of handicap be excluded from participation in, be denied the benefit of, or be subjected to discrimination under any program or activity receiving Federal finance assistance. Employment discrimination on the basis of handicap 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 on the basis of sex shall be excluded from participation in, be denied the benefit 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. 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. 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 certain questions, EPA program officials should be contact for clarification. EPA Form 4700-4 (Rev. 1/90) Reverse ITEMS IA. "Applicant" means any entity that files an application or unsolicited proposal or otherwise requests EPA assistance. IB. "Recipient" means any entity, other than applicant, which will actually receive EPA assistance. IC. Self-explanatory. II. Self-explanatory. III. "Civil rights lawsuits" means any lawsuit or complaint alleging discrimination on the basis of race, color, national origin, sex, age or handicap pending against the applicant and/or entity which actually benefits from the grant. 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. IV. "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 handicap. If any part of the review covered the entity which will actually benefit from the grant, it should be listed. V. Self-explanatory. VI. The word "community" refers to the area under the applicant's and/or recipient's jurisdiction. The "community" might be a university or laboratory campus, or a community within a large city. If there is a significant disparity between minority and nonminority populations to receive service, not otherwise satisfactorily explained, the Regional office may require a map which indicates the minority and nonminority population served by this project, program or activity. VII. This information is required so that reviewers may determine if a disparity in the proposed provision of services will exist in the event the application is approved for funding. Give population of recipient's jurisdiction, broken out by categories as specified. In the event the applicant cannot provide the requested information because the funds will be distributed over a wide demographic area which is yet to be determined, an explanation may be provided on a separate sheet. For example, a State applying for a capitalization grant under the State Revolving Fund program may not know which cities and counties will apply for, and receive, SRF loans. VIII. Self-explanatory. IX. "Jurisdiction" means the geographical area over which applicant has the authority to provide service. X. Self-explanatory. "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 viewing 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 Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W., Washington, D.C. 20460; and to the office of information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503. G   . 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