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FORM TITLE: Sewage Facilities Act Enforcement Reimbursement
OFFICIAL NUMBER: 3640-FM-WQ0280
DUE DATE: Early March
WHERE TO SEND COMPLETED FORM: Bureau of Water Quality Management
Division of Municipal Planning and Finance
PA Dept. of Environmental Protection
P.O. Box 8466
Harrisburg, PA 17105-8466
NUMBER OF COPIES REQUIRED: Two copies with original signatures and seals; one copy
of supporting documents
FOR ASSISTANCE: Bureau of Water Quality Management (717) 787-6744
FAILURE TO SUBMIT FORM RESULTS IN: Loss of reimbursement of eligible
expenditures
PRIOR TO COMPLETING, ASSEMBLE THE FOLLOWING INFORMATION:
• Report from Sewage Enforcement Officer on reporting year’s activity
• Report on all applications taken by municipality
• Payroll records and W-2s for municipal personnel involved in permits and payroll
functions
• Federal 1099 form issued to Sewage Enforcement Officer, if treated as contractor
HELPFUL HINTS:
Include ALL costs associated with processing any related payroll or vendor expenses, such as:
• personnel involved in the sale of applications,
• building permit official (who must also verify that permit was issued to applicant),
• time and cost of copying applications and mailing to permit officer,
• time preparing annual reimbursement form,
• fax requests,
• time involved in answering permit-related questions,
• cost associated with violations, and
• cost of copying records for reimbursement application.
V-55
Revised July 2003