
1
STATE
SMALL
BUSINESS
STATIONARY
SOURCE
TECHNICAL
AND
ENVIRONMENTAL
COMPLIANCE
ASSISTANCE
PROGRAM
(
SBTCP)

ANNUAL
REPORTING
FORM
FOR
THE
PERIOD
1/
1/
01
TO
12/
31/
01
OMB
NO.:
2060­
0337
EXPIRATION
DATE:
x/
xx/
xx
***
Completed
forms
are
due
by
March
1,
2002
***

This
is
the
Annual
Reporting
Form
for
the
State
Small
Business
Stationary
Source
Technical
and
Environmental
Compliance
Assistance
Programs
(
SBTCPs)
under
the
Clean
Air
Act
(
CAA)
as
amended
in
1990.
We
are
collecting
objective
information
on
each
SBTCP.
This
report
is
not
an
evaluation
of
your
program.

INSTRUCTIONS
FOR
COMPLETING
THIS
FORM
1.
Please
complete
the
web­
enabled
version
of
the
Form.
Do
not
answer
questions
by
referring
to
attached
documents
or
a
previous
SBTCP
report.

2.
You
should
already
collect
the
requested
information.
If
a
question
asks
for
data
you
do
not
have,
please
briefly
explain
why
it
is
not
available.
For
future
reports,
you
may
need
to
revise
the
statistics
that
you
track.

3.
Each
answer
block
(
with
the
noted
exceptions)
must
contain
information
to
be
answered
complete.
If
part
of
the
question
does
not
apply,
indicate
"
not
applicable",
"
NA",
or
another
appropriate
answer.

4.
Submit
your
completed
form
by
clicking
on
the
large
"
submit
this
form"
button
on
the
opening
page.
Click
this
button
only
when
all
answers
are
complete
and
they
have
been
reviewed
by
all
necessary
parties.
Clicking
on
this
button
will
permanently
lock
and
submit
your
form.

WHAT
IF
I
HAVE
QUESTIONS?

If
you
have
any
comments
on
how
to
improve
this
Form,
please
call
the
U.
S.
EPA
Small
Business
Ombudsman
(
EPA
SBO),
at
202­
260­
0490
or
800­
368­
5888,
Monday
through
Friday,
8:
30
AM
­
5:
00
PM
(
EST).
After
these
hours,
you
can
leave
a
message
on
the
answering
machine.

For
any
technical
questions
on
completing,
printing,
or
submitting
your
form,
please
contact
Angel
Martin­
Dias
at
412­
577­
2643
or
e­
mail
martindias@
ctc.
com.

WHY
IS
EPA
REQUESTING
THIS
FORM?

As
part
of
the
CAA,
the
U.
S.
Congress
required
that
each
state
and
territory
establish
a
Small
Business
Stationary
Source
Technical
and
Environmental
Compliance
Assistance
Program
(
SBTCP)
to
help
small
businesses
comply
with
this
Act.
As
part
of
its
reporting
requirements
to
Congress,
EPA
includes
information
about
the
SBTCP
programs
using
information
you
provide
on
this
Form.
EPA
has
given
the
responsibility
for
this
report
to
its
SBO,
who
uses
this
Form
as
a
standard
information
collection
tool.

SUGGESTIONS
FOR
COMPLETING
THIS
FORM
$
Gathering
information
for
this
report
is
definitely
a
team
effort!
Enlist
the
help
of
key
contacts
from
the
SBO,
the
SBAP,
and
the
CAP,
and
ask
them
to
complete
applicable
sections.

$
One
person
should
take
responsibility
to
complete
and
submit
this
Form
(
most
likely
the
SBO).
2
$
Refer
to
last
year's
Report
to
Congress
and
the
information
you
provided
on
your
Reporting
Form
last
year
when
completing
this
year's
Reporting
Form.

PROGRAM
INFORMATION
State,
territory,
or
local
agency
for
which
this
report
is
being
submitted.

REPORTING
FORM
CONTACT
Name
Title
Agency/
Organization
Address
City,
State,
Zip
Telephone
Number
Facsimile
Number
E­
mail
BUDGET
Record
the
combined
budget
for
your
SBO,
SBAP,
and
CAP
for
calendar
year
2001.
(
If
your
budget
is
by
fiscal
year,
please
indicate
the
FY
budget
that
is
in
effect
as
of
12/
31/
01.)

2001
Budget
STAFFING
How
many
people,
measured
as
full­
time
equivalents
(
FTEs),
support
the
SBO
and
SBAP?

Total
FTEs
What
is
the
status
of
your
CAP
as
of
the
end
of
2001?

Status
Check
if
applicable
Complete
(
at
least
7
members)?
3
Active
(
holding
regular
meetings,
conducting
activities,
etc.)?

OUTREACH
AND
TECHNICAL
ASSISTANCE
Does
your
program
offer
air­
only
or
multimedia
assistance?

Air
only
Multimedia
Please
indicate
the
requested
data
for
each
type
of
activity
during
2001.

ACTIVITY
TOTALS
Hotline/
e­
mail
#
calls/
e­
mails
=

Onsite
visit
#
visits
=

Seminars/
workshops
#
events
=
#
participants
=

Publications/
mailings
#
documents
=
#
copies
distributed
=

Home
page
#
hits
=

Video
&
Teleconferences
#
events
=
#
attendees
=

Permit
applications
#
permits
=

Other
#
=

TOTAL
ASSISTS
Please
include
any
information
about
your
program
that
you
would
like
to
highlight,
such
as
significant
accomplishments,
awards,
move
to
multimedia,
etc.
Case
studies
are
especially
appreciated!
