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Forms

Our application packages are available for download as multi-page PDF files. The forms were created in the Adobe PDF format (Version 4.0). Each form has been developed in order to accommodate the entry of the required information directly from a PC. For additional information regarding entry of data into the forms, please use your software's help file. If you don't already have the Adobe PDF Reader, you may direct your browser to www.adobe.com to download the current version of "Adobe Acrobat Reader".

Each package contains all the necessary forms and additional information regarding ineligible costs, submission format, etc. Please review all forms thoroughly prior to submission.

Following the review of an "administratively complete" application a recommendation will be presented to the Board for a vote of approval. Incomplete applications will be returned for correction. Complete applications must be submitted on or prior to the published deadline in order to be reviewed for the subsequent Disbursement meeting of the Board.

Compliance Request
This package should be used as the first submission to the Board. These forms are used to establish your sites compliance status. A $150.00 fee is required with submission of this package. Following the submission of these forms the Department of Environmental Management (DEM) will review the compliance history of your site.

Request for Reimbursement
Following notification that your site has been found to be “in compliance”, this package should be submitted. These forms are required in order to verify that the release/site is eligible and that the $20,000.00 deductible has been spent on eligible costs.

Supplemental Request
This package should be used for the submission of additional expenses incurred during remediation and for the resubmittal of expenses previously designated as “No Backup”.

Common Forms
These forms are applicable to all reimbursement requests. Where appropriate, forms must be completed and submitted. If a subrogation, disclaimer, and W-9 have previously been filed for a site, do not resubmit.


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