OMB CONTROL NO.2030-0020

APPROVED:   12/30/02

APPROVAL EXPIRES:  12/31/05

U.S. ENVIRONMENTAL PROTECTION AGENCY

MBE/WBE UTILIZATION UNDER FEDERAL GRANTS, COOPERATIVE

AGREEMENTS, AND INTERAGENCY AGREEMENTS

PART 1.  (Reports are required even if no procurements are made during
the reporting period.)



1A.  FEDERAL FISCAL YEAR

       200_______	

1B.  REPORTING PERIOD (Check ALL appropriate boxes)

 ( 1st (Oct-Dec)     ( 2nd (Jan-Mar)    ( 3rd (Apr-Jun)    (  4th
(Jul-Sep)      ( Annual 

 ( Check if this is the last report for the project (Project completed).



1C.  REVISION OF A PRIOR REPORT?  Y or N

        Year:       _________

         Quarter: _________	

BRIEFLY DESCRIBE THE REVISIONS YOU ARE MAKING:



2A.  EPA FINANCIAL ASSISTANCE OFFICE ADDRESS

            ( ATTN: DBE Coordinator)

	

3A.  RECIPIENT NAME AND ADDRESS





2B.  EPA DBE COORDINATOR

Name:

E-mail:	

2C.  PHONE:

Fax:	

3B.  RECIPIENT REPORTING CONTACT:

Name:

E-mail:	

3C.  PHONE:

Fax:



4A.  FINANCIAL ASSISTANCE AGREEMENT ID NUMBER

         (SRF State Recipients, refer to Instructions for Completion of
blocks

         4A, 5A  and 5C.)

	

4B.  FEDERAL FINANCIAL ASSISTANCE PROGRAM TITLE or CFDA 

       NUMBER:



5A.  TOTAL ASSISTANCE AGREEMENT AMOUNT

(SRF State Recipients, refer to Instructions for Completion of blocks
4A, 5A and 5C.)

        EPA Share:    $_______________________

        Recipient Share: $_____________________	

  5B.   If NO procurement and NO accomplishments were made this
reporting period, check and skip to Block No. 7.   (Procurements are all
expenditures through contract, order, purchase, lease or barter of
supplies, equipment, construction, or services needed to complete
Federal assistance programs.  Accomplishments, in this context, are
procurements made with MBEs and/or WBEs.         

                                                       ( 





5C.                                  Total Procurement and MBE/WBE
Accomplishments This Reporting Period By:

                                                             (Only
include amount not reported in any prior reporting period)

   

Have sub-awards and/or subcontracts been issued under this assistance
agreement?  Yes ______        No________ 

Total Procurement Amount $________________________ (Include total dollar
values awarded by recipient, sub-recipients and SRF loan recipients.)

Actual MBE/WBE Procurement Accomplished:

(Include total dollar values awarded by recipient, sub-recipients, SRF
loan recipients and Prime Contractors.)

                           Construction                            
Equipment                        Services                             
Supplies                       Total

    $MBE:             ____________                        _____________ 
               _____________                  _____________         
________________

               

    $WBE:            ____________                        ______________ 
             ______________                 _____________         
________________





6.  COMMENTS: (If no MBE/WBE procurements were accomplished during the
reporting period, please explain what steps you are taking to achieve
the MBE/WBE Program requirements specified in the terms and conditions
of the Assistance Agreement.)





7.  NAME OF RECIPIENT(S  AUTHORIZED REPRESENTATIVE

	

TITLE





8.  SIGNATURE OF RECIPIENT(S AUTHORIZED REPRESENTATIVE

	

DATE



EPA FORM 5700-52A  available electronically at
http://www.epa.gov/osdbu/5700_52a.pdf



MBE/WBE PROCUREMENTS MADE DURING REPORTING PERIOD

EPA Financial Assistance Agreement Number: _______________

1.  Procurement Made By	

2.  Business Enterprise	

3.  $ Value of 

     Procurement	

4.  Date of              Award

      MM/DD/YY	

5.  Type of                 Product or  

     ServicesA

     (Enter Code)	

6.  Name/Address/Phone Number of MBE/WBE         Contractor or Vendor



Recipient	

Sub-Recipient and/or SRF Loan Recipient	

Prime	

Minority	

Women







	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





	

	

	

	

	

	

	

	





AType of product or service codes:

1 = Construction			2 = Supplies				3 = Services			4 = Equipment			

         	

Note:  Refer to Terms and conditions of your Assistance Agreement to
determine the frequency of reporting.  Recipients are required to submit
MBE/WBE reports to EPA beginning with the Federal fiscal year quarter
the recipients receive the award, continuing until the project is
completed. 				

EPA FORM 5700-52A -  (Approval Expires 12/31/05)INSTRUCTIONS

MBE/WBE UTILIZATION UNDER FEDERAL ASSISTANCE AGREEMENTS AND INTERAGENCY
AGREEMENTS

EPA FORM 5700-52A

A. General Instructions:

MBE/WBE utilization is based on Executive Orders 11625, 12138, 12432,
P.L. 102-389 and EPA Regulations Part 30 and 31.  EPA Form 5700-52A must
be completed by recipients of Federal grants, cooperative agreements, or
other Federal financial assistance which involve procurement of
supplies, equipment, construction or services to accomplish Federal
assistance programs.

Recipients are required to report 30 days after the end of each federal
fiscal quarter or annually, per the terms and conditions of the
financial assistance agreement.  Submission dates are January 30, April
30, July 30, and October 30.  The submission date for annual reports is
October 30. MBE/WBE program requirements, including reporting, are
material terms and conditions of the financial assistance agreement.

B.  Definitions:

Procurement is the acquisition through contract, order, purchase, lease
or barter of supplies, equipment, construction or services needed to
accomplish Federal assistance programs.

A contract is a written agreement between an EPA recipient and another
party (also considered (prime contracts() and any lower tier agreement
(also considered (subcontracts() for equipment, services, supplies, or
construction necessary to complete the project.  This definition
excludes written agreements with another public agency.  This definition
includes personal and professional services, agreements with
consultants, and purchase orders. 

A minority business enterprise (MBE) is a business concern that is (1)
at least 51 percent owned by one or more minority individuals, or, in
the case of a publicly owned business, at least 51 percent of the stock
is owned by one or more minority individuals; and (2) whose daily
business operations are managed and directed by one or more of the
minority owners.

U.S. citizenship is required.  Recipients shall presume that minority
individuals include Black Americans, Hispanic Americans, Native
Americans, Asian Pacific Americans, or other groups whose members are
found to be disadvantaged by the Small Business Act or by the Secretary
of Commerce under section 5 of Executive order 11625.  The reporting
contact at EPA can provide additional information.

A woman business enterprise (WBE) is a business concern that is, (1) at
least 51 percent owned by one or more women, or, in the case of a
publicly owned business, at least 51 percent of the stock is owned by
one or more women and (2) whose daily business operations are managed
and directed by one or more of the women owners.

Business firms which are 51 percent owned by minorities or women, but
are in fact managed and operated by non-minority individuals do not
qualify for meeting MBE/WBE procurement goals.  U.S. Citizenship is
required.

The following affirmative steps for utilizing MBEs and WBEs must be
documented.  Such documentation is subject to EPA review upon request:

Include of MBEs/WBEs on solicitation lists.

2.  	Assure that MBEs/WBEs are solicited once they are identified.

3.  	Divide total requirements into   smaller tasks to permit maximum
MBE/WBE participation, where feasible.

4. 	Establish delivery schedules which will encourage MBE/WBE
participation, where feasible.   

5. 	Encourage use of the services of the U.S.  Department of Commerce's
Minority Business Development Agency (MBDA) and the U.S. Small Business
Administration to identify MBEs/WBEs.

6.  	Require that each party to a subgrant, subagreement, or contract
award take the affirmative steps outlined here.

C. Instructions for Part I:

1a.	Specify Federal fiscal year this report covers. The Federal fiscal
year runs from October 1st through September 30th (e.g. November 29,
2005 falls within Federal fiscal year 2006)

1b.	Check applicable reporting box, quarterly or annually.  Also
indicate if this is the last report for the project. 



1c.	Indicate if this is a revision to a previous year or quarter, and
provide a brief description of the revision you are making.

2a-c.  	Please refer to your financial assistance agreement for the
mailing address of the EPA financial assistance office for your
agreement.

The (EPA DBE Reporting Contact( is the DBE Coordinator for the EPA
Region from which your financial assistance agreement was originated. 
For a list of DBE Coordinators please refer to the EPA OSDBU website at
www.epa.gov/osdbu.  Click on (Regional Contacts( for the name of your
coordinator.		

3a-c.  	Identify the agency, state authority, university or other
organization which is the recipient of the Federal financial assistance
and the person to contact concerning this report.

4a.  	Provide the Assistance Agreement or Interagency Agreement number
assigned by EPA. A separate report must be submitted for each Assistance
Agreement or Interagency Agreement.

*For SRF recipients: In box 4a list numbers for ALL open Assistance
Agreements. SRF recipients will report activity for all Agreements on
one form.

4b. 	Refer back to Assistance Agreement document for this information.

5a. 	Provide the total amount of the Assistance Agreement which includes
Federal funds plus recipient matching funds and funds from other
sources.

*For SRF recipients only: SRF recipients will not enter an amount in 5a.
 Please leave 5a blank.

5b. 	Self-explanatory.

5c. 	Provide the total dollar amount of all contracts/procurements
awarded this reporting period.  For example:  Actual dollars for
procurement from the procuring office; actual contracts let from the
contracts office; actual goods, services, supplies, etc., from other
sources including the central purchasing/ procurement centers).  This
total includes all contracts/procurements made by the recipient,
sub-recipients, SRF loan recipients, and prime contractors

Where requested, also provide the dollar amount of all MBE/WBE
procurement awarded during this reporting period by the recipient,
sub-recipients, SRF loan recipients, and prime contractors. These
amounts include the Federal, State and  local shares in the procurement
awards.

*For SRF recipients only:  In 5c please enter the total procurement
amount for the quarter under all of your SRF Assistance Agreements. The
figure reported in this section is not directly tied to an individual
Assistance Agreement identification number. (SRF state recipients report
state procurements in this section)

6.  	If there were no MBE/WBE accomplishments this reporting period,
please briefly explain what steps you are taking in furtherance of the
MBE/WBE requirements specified in the terms and conditions of the
Assistance Agreement.

7.  	Name and title of official administrator or designated reporting
official.

8.  	Signature and month, day year report submitted.

D. Instructions for Part II:

For each MBE/WBE procurement made under this assistance agreement during
the reporting period, provide the following information:

1.  	Check whether this procurement was made be the recipient,
sub-recipient/SRF loan recipient, or the prime contractor. 

2.  	Check either the MBE or WBE column.  If a firm is both an MBE and
WBE, the recipient may choose to count the entire procurement towards
EITHER it(s MBE or WBE accomplishments.  The recipient may also divide
the total amount of the procurement (using any ratio it so chooses) and
count those divided amounts toward it(s MBE and WBE accomplishments.  If
the recipient chooses to divide the procurement amount and count
portions toward it(s MBE and WBE accomplishments, please state the
appropriate amounts under the MBE and WBE columns on the form.  The
combined MBE and WBE amounts for that MBE/WBE contractor must not exceed
the (Value of the Procurement( reported in column #3.

3.  	Dollar value of procurement.

4.	Date of award, shown as month, day, and year.  Date of award is
defined as the date the contract or procurement was awarded, not the
date the contractor received payment under the awarded contract or
procurement, unless payment occurred on the date of award.  (Where
direct purchasing is the procurement method, the date of award is the
date the purchase was made).

5.	Using codes at the bottom of the form, identify type of product or
service acquired through this procurement (e.g., enter 1 if
construction, 2 if supplies, etc).

6.	Name, address, and telephone number of MBE/WBE firm.

This data is requested to comply with provisions mandated by: statute or
regulations (40 CFR Part 30 and 31); OMB Circulars; or added by EPA to
ensure sound and effective assistance management.  Accurate, complete
data are required to obtain funding, while no pledge of confidentiality
is provided.

The public reporting and recording burden for this collection of
information is estimated to average l hour per response annually. 
Burden means the total time, effort, or financial resources expended by
persons to generate, maintain, retain, or disclosure or provide
information to or for a Federal agency.  This includes the time needed
to review instructions; develop, acquire, install, and utilize
technology and systems for the pruposes of collecting, validating, and
verifying information, processing and maintaining information, and
disclosing and providing information; adjust the existing ways to comply
with any previously applicable instructions and requirements; train
personnel to be able to respond to a collection of information; search
data sources; complete and review the collection of information; and
transmit or otherwise  disclose the information.  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.

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, OPPE Regulatory Information
Division, U.S. Environmental Protection Agency (2136), 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.

