1. MUNICIPAL WASTE PLANNING GRANTS
      1. UNDER SECTION 901 OF ACT 101
      2. THE MUNICIPAL WASTE PLANNING, RECYCLING AND WASTE REDUCTION ACT
      3. OF JULY 1988
  2. PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
    1. BUREAU OF WASTE MANAGEMENT
    2. DIVISION OF WASTE MINIMIZATION AND PLANNING
    3. www.depweb.state.pa.us
      1. PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
      2. BUREAU OF WASTE MANAGEMENT
      3. ACT 101
      4. PLANNING GRANTS
      5. FACT SHEET

MUNICIPAL WASTE PLANNING GRANTS
UNDER SECTION 901 OF ACT 101
THE MUNICIPAL WASTE PLANNING, RECYCLING AND WASTE REDUCTION ACT
OF JULY 1988

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PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
www.depweb.state.pa.us
2520-FM-BWM0013.2
Rev. 10/2015
901

2520-FM-BWM0013.2
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PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
ACT 101
PLANNING GRANTS
FACT SHEET
The 901 Grant Program:
Grants are authorized under Section 901 of the Municipal Waste Planning, Recycling and Waste
Reduction act (Act 101 of July 1988).
All grants are allocated from the Recycling Fund authorized under Act 101.
Section 901 grants are available to all Pennsylvania counties for the following:
(1) The cost of preparing municipal waste management plans in accordance with Chapter 272
Subchapter C (relating to municipal waste planning);
(2) The cost of carrying out related studies, surveys, investigations, inquiries, research and analyses,
including those relating to siting;
(3) Environmental mediation;
(4) Feasibility studies and project development for municipal waste processing, disposal or
composting facilities, except for facilities for the combustion of municipal waste that are not
proposed to be operated for the recovery of energy;
(5) Educational programs or pollution prevention, other technical assistance to small business for
pollution prevention and educational programs on household hazardous waste (HHW).
Costs:
The grant to a county cannot exceed 80% of approved project costs. No county may request or
receive more than $75,000 per calendar year for planning (utilize Application A). In addition, a county
may also request up to $75,000 every two years for costs associated with HHW educational programs
(utilize Application B). HHW educational costs incurred on January 1, 2016 or beyond will be eligible
for grant funding.
Approved costs are "Direct Costs" consisting of staff time, consultant's time, subcontractor's time,
HHW education, administration of the HHW education program, in-kind services, travel and supplies
required, and other miscellaneous costs, to satisfactorily complete the Scope of Work.
In-kind
services may only be claimed as match. All other approved costs may be utilized toward the
applicant's match requirement. Indirect costs are ineligible for grant funding or as match.
Costs not approved for a grant under this program include, but are not limited to:
(1) County Recycling Coordinators who apply for a section 903 grant.
(2) Capital costs such as equipment and construction;
(3) Direct salaries;
(4) Costs incurred in preparing a grant application;
(5) Indirect costs as defined in Office of Management and budget Circular A-87, as amended, entitled
"Cost Principles for State, Local and Indian Tribal Governments," 60 FR 266.484 (1995);
(6) Costs reimbursed under any other Department grant.
?
Definition of Direct and Indirect Costs:
"Direct Costs" is an accounting term for costs that are clearly and exclusively associated with a
service or product and treated as such in cost accounting systems.
Direct costs are those that can be identified specifically with a particular cost objective. These costs
may be charged directly to grants, contracts, or to other programs against which costs are finally
lodged. Typical direct costs chargeable to grant programs are:
1. Compensation of employees for the time and efforts devoted exclusively to the execution of grant
programs;
2. Cost of materials acquired, consumed, or expended specifically for the purpose of the grant;

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3. Other items of expense incurred specifically to carry out the grant agreement.
Examples of Direct Costs:
?
Long distance and conference telephone charges
?
Printing and copying expenses
?
Postage
?
Hourly rate of employees for hours worked on grant project (includes secretary's time also)
?
Benefit rate of employees for hours worked on grant project
?
Profit
?
Legal advertising and services
?
Travel related costs (Commonwealth Management Directive 230.10)
"Indirect Costs" are those incurred for a common or joint purpose benefiting more than one cost
objective, and not readily assignable to the cost objectives specifically benefited without effort
disproportionate to the results achieved. The term applies to costs of this type originating in the
grantee department as well as those incurred by other departments in supplying goods, services, and
facilities to the grantee.
"Indirect Costs" is often used synonymously with "overhead" or "hidden" costs as comprising all costs
that are not accounted for as the direct costs of a particular service, product, process, system, or
facility. The underlying distinction is between (1) costs that are either pooled and allocated on the
basis of some formula, or not allocated at all, and (2) costs that an accounting system treats as
belonging (directly) to a service, product, process, system, or facility (i.e. a cost center, in accounting
terminology).
Major identifying characteristics of indirect costs are:
?
They apply to more than one project
?
They represent an "overhead" or general cost of doing business, for a company or a government
?
They do not include profit
Examples of Indirect Costs (General Company Overhead):
?
Utilities
?
Building and equipment maintenance and repair
?
Administrative and accounting costs
?
Depreciation
?
Office space rental and equipment rental
?
General telephone service
?
Office supplies and materials
?
Professional registrations and technical seminars
?
Auditing professional services
?
Proposal and pre-contract costs
?
Training and professional development costs
?
Corporate insurances
?
Corporate taxes
Indirect costs may be identified on an invoice or disbursement request as indirect costs but, more
often, they may appear as an administrative, contingency, or general costs. They are generally
expressed as a percent of the billable total or of the project total.
Contracting & Reimbursement:
If the application is funded, a grant agreement will be developed between the applicant and the
Department. All reimbursable expenditures and applicant match must be incurred prior to the contract
termination date, which is two years from the date on which funds for the agreement were
encumbered (the encumbrance of funds takes place just prior to the finalization—full execution—of
the grant agreement). These dates will be provided in the grant agreement and any accompanying
correspondence. The agreement will also contain a Spending Schedule, which will establish the
amount of grant eligible costs expected to be incurred for each quarter of the grant contract period.

2520-FM-BWM0013.2
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The submission of Disbursement Requests and Progress Reports should be predicated on this
schedule. All disbursements are on a cost reimbursement basis.

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 1 -
APPLICATION A
Instructions for
Filing the Application for
Act 101, Section 901 Grant
Planning
GENERAL
Applications may be submitted at any time during the year. Prior to the submittal of an application, the
applicant must meet with the appropriate DEP Regional Planning and Recycling Coordinator to discuss
the proposed project and the grant requirements. Two copies of each application must be submitted to
the following address:
Pennsylvania Department of Environmental Protection
Bureau of Waste Management
Division of Waste Minimization and Planning
PO Box 8472
Harrisburg, PA 17105-8472
Please use recycled paper when submitting your application.
A completed application consists of:
a.
Part I – Applicant Information
b.
Part II – Project Summary and Justification
c.
Part III – Project Scope of Work
d.
Part IV – Project Financial Data
e.
Part V – Taxpayer Identification Number and Certification (Form W-9)
f.
Part VI – Supporting Documents
Any application deemed incomplete by the Department will be returned to the applicant.
PART I – APPLICANT INFORMATION
A.
The applicant must be the governing body of the county. Authorities and other associated bodies
are not eligible to apply.
B.
The contact person is the person who will be the point of contact for this project with the
Department.
C.
Please enter the telephone number and fax number of the contact person.
D.
Please enter the email address of the contact person.
E.
Please enter the address of the contact person if different that the applicant's address.
F.
Please enter the date on which you meet with the appropriate DEP Regional Planning Coordinator
to discuss this project and grant application (failure to meet this requirement will result in your
application being returned).
Statement and Verification: The application must be signed by an authorized official of the county.
PART II – PROJECT SUMMARY AND JUSTIFICATION
Please provide a summary of the municipal waste management or pollution prevention or household
hazardous waste problems confronting the county and how the proposed project will meet Act 101
planning and plan implementation requirements and, if applicable, the requirements of Act 190, in solving
the described problems. Indicate what other sources of funding have been evaluated/applied for and what
could occur should this §901 grant application not be approved. Please keep this summary to one page, if
possible.

2520-FM-BWM0013.2
Rev. 10/2015
Application A
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PART III – PROJECT SCOPE OF WORK
Divide the work tasks necessary to complete the project into the appropriate cost categories (1. County
Personnel Costs; 2. Benefits; 3. Supplies/Printing; 4. Travel; 5. Consultants & Subcontractors; 6. In-Kind
Services). On the appropriate Scope of Work Cost Category page, describe the work to be performed
under that category for which funds will be requested or utilized as match. Describe in detail how this
work relates to the overall project completion. Be specific, delineating work items rather than making
broad generalizations.
Describe what end products will be produced (reports, plans, materials, etc.) as a result of the work
performed. A paper copy and one copy on CD of any end product must be submitted to the appropriate
DEP Regional Office and one copy on CD must be submitted to the Division of Waste Minimization and
Planning in Harrisburg. The CD version may be used for all other distribution at the county's discretion.
Expenses for this may be included in the "Supplies/Printing" budget category.
PART IV – PROJECT FINANCIAL DATA
A.
BUDGET CATEGORY DATA
1.
County Personnel Costs refer to those costs of time incurred by county staff to complete work
tasks associated with the project.
2.
Benefits refer to those costs incurred by county staff, exclusive of direct salaries, associated
with the time spent on completing work tasks associated with the project.
3.
Supplies/Printing refers to those costs associated with the production of reports, plans,
materials, etc.
4.
Travel refers to lodging, subsistence, mileage, etc., costs incurred by county personnel or
those under contract to the county in the performance of work tasks associated with the
project. All travel occurring outside of the Commonwealth and exceeding $300 or exceeding
300 miles from the Applicant's place of business must be pre-approved by the Department.
5.
Consultants & Subcontractors refer to costs associated with the hiring of professional services
to perform work tasks associated with the project. Indirect costs are not eligible.
6.
In-Kind Services refer to work performed on the project for which no outlay of cash occurred.
The value of these services may be claimed as part of the applicant's match. Volunteer and
pro-bono services are considered in-kind. A maximum of 10% of the total project cost may
consist of in-kind service costs.
7.
Total Project Costs: Indicate the total project cost and the amount to be paid by the county
and by DEP. Total Project Cost is equal to all project costs required to complete the Scope of
Work. DEP Share cannot exceed 80% of the total project costs. Applicant Match cannot be
less than 20% of the total project cost.
B.
GRANT EXPENDITURE SCHEDULE
When completing the Grant Expenditure Schedule, estimate the percentage of the total DEP share costs
to be incurred in 6 month intervals from the time you receive the agreement for this grant (if awarded).
You will have an opportunity to adjust this schedule when the grant agreement is drafted. Not every
quarter must show an expenditure, but the total for all four quarters must equal 100%. Please use whole
numbers.
C.
RELATED FINANCIAL INFORMATION
Please answer questions 1 and 2. If the question is not applicable to your project, please indicate—do not
leave the question blank.
PART V – TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION (FORM W-9)
Please complete the form provided. You cannot be awarded a grant unless this form is complete and
accurate. Please use the County's Taxpayer Identification Number Only.
PART VI – SUPPORTING DOCUMENTS
Please attach any supporting documents (bids, quotes, drafts, etc.) to your application as needed.

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 3 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING FOR
Application A: Planning
PART I - APPLICANT INFORMATION
PLEASE FOLLOW ALL INSTRUCTIONS AS PROVIDED
A.
APPLICANT:
BUSINESS ADDRESS:
STREET:
CITY:
PA
ZIP:
B.
CONTACT PERSON:
MR.
MS.
C.
TELEPHONE NUMBER: (
)
FAX NUMBER: (
)
D.
CONTACT PERSON EMAIL ADDRESS:
E.
ADDRESS OF CONTACT PERSON IF DIFFERENT FROM ABOVE:
STREET:
CITY:
PA
ZIP:
F.
DATE OF PRE-APPLICATION MEETING WITH DEP COORDINATOR:
Month
Day
Year
STATEMENT AND VERIFICATION
The above information is true and correct to the best of my personal knowledge or information and belief.
This statement and verification is made subject to the penalties of 18 Pa. C.S.A. § 4904 relating to unsworn
falsification to authorities, which provides that if I make knowingly false averments, I may be subject to
criminal penalties.
Signature of Elected/Appointed Municipal Official
Title
Date

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 4 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART II – PROJECT SUMMARY AND JUSTIFICATION

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 5 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
1. COUNTY PERSONNEL COSTS

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 6 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
2. BENEFITS

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 7 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
3. SUPPLIES/PRINTING

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 8 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
4. TRAVEL
Travel costs occurring outside of the Commonwealth and exceeding $300 or exceeding 300 miles from
the Applicant's place of business must be pre-approved by the Department.

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 9 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
5. CONSULTANTS & SUBCONTRACTS
Please include your consultant's bid package, and any related subcontracts, under
Part VI - Supporting Documents of this Application.

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 10 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
6. IN-KIND SERVICES

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 11 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART IV – PROJECT FINANCIAL DATA
Using the Project Scope of Work and the application instructions, complete the following table:
A.
BUDGET CATEGORY DATA
BUDGET ITEM
TOTAL
ITEM
COST
DEP SHARE
APPLICANT
MATCH
1.
COUNTY PERSONNEL COSTS
2.
BENEFITS
3.
SUPPLIES/PRINTING
4.
TRAVEL
5.
CONSULTANTS & SUBCONTRACTS
6.
IN KIND SERVICES*
TOTAL PROJECT COSTS
*Maximum of 10% of Total Project Costs
B.
GRANT EXPENDITURE SCHEDULE
1.
What percentage of the total DEP share costs do you anticipate incurring during the
first 6 months after receiving your grant agreement?
%
2.
What additional percentage of the total DEP share costs do you anticipate incurring
during the following 12 months after receiving your grant agreement?
%
3.
What additional percentage of the total DEP share costs do you anticipate incurring
during the following 18 months after receiving your grant agreement?
%
4.
What additional percentage of the total DEP share costs do you anticipate incurring
during the following 24 months after receiving your grant agreement?
%
Total
100%

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 12 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART IV – PROJECT FINANCIAL DATA (CONTINUED)
C.
RELATED FINANCIAL INFORMATION
N/A
1.
Describe the nature of the match indicated in Part IV A. If any portion of this match is to be in-kind services,
indicate the manner in which the value of these services were determined:
N/A
2.
Indicate the names of consulting firms and/or subcontractors, if known, that will be utilized in the completion
of the project and the manner in which they were chosen. Indicate how costs for their services were
established:

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 13 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART V – TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION – Form W-9

2520-FM-BWM0013.2
Rev. 10/2015
Application A
- 14 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART VI – SUPPORTING DOCUMENTS

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 1 -
APPLICATION B
Instructions for
Filing the Application for
Act 101, Section 901 Grant
HHW Education
GENERAL
Applications may be submitted at any time during the year. Prior to the submittal of an application, the
applicant must meet with the appropriate DEP Regional Planning and Recycling Coordinator to discuss
the proposed project and the grant requirements. Two copies of each application must be submitted to
the following address:
Pennsylvania Department of Environmental Protection
Bureau of Waste Management
Division of Waste Minimization and Planning
PO Box 8472
Harrisburg, PA 17105-8472
Please use recycled paper when submitting your application.
A completed application consists of:
a.
Part I – Applicant Information
b.
Part II – Project Summary and Justification
c.
Part III – Project Scope of Work
d.
Part IV – Project Financial Data
e.
Part V – Taxpayer Identification Number and Certification (Form W-9)
f.
Part VI – Supporting Documents
Any application deemed incomplete by the Department will be returned to the applicant.
PART I – APPLICANT INFORMATION
A.
The applicant must be the governing body of the county. Authorities and other associated bodies
are not eligible to apply.
B.
The contact person is the person who will be the point of contact for this project with the
Department.
C.
Please enter the telephone number and fax number of the contact person.
D.
Please enter the email address of the contact person.
E.
Please enter the address of the contact person if different that the applicant's address.
F.
Please enter the date on which you meet with the appropriate DEP Regional Planning Coordinator
to discuss this project and grant application (failure to meet this requirement will result in your
application being returned).
Statement and Verification: The application must be signed by an authorized official of the county.
PART II – PROJECT SUMMARY AND JUSTIFICATION
Please provide a summary of the pollution prevention or household hazardous waste problems
confronting the county in the past and how the proposed project will address Act 190 in solving the
described problems. Indicate what other sources of funding have been evaluated/applied for and what
could occur should this §901 grant application not be approved. Please keep this summary to one page, if
possible.

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 2 -
PART III – PROJECT SCOPE OF WORK
Divide the work tasks necessary to complete the project into the appropriate cost categories (1. HHW
Educational Costs; 2. HHW Education Administration). On the appropriate Scope of Work Cost Category
page, describe the work to be performed under that category for which funds will be requested or utilized
as match. Describe in detail how this work relates to the overall project completion. Be specific,
delineating work items rather than making broad generalizations.
Describe what end products will be produced (reports, plans, materials, education, etc.) as a result of the
work performed. A paper copy and one copy on CD of any end product must be submitted to the
appropriate DEP Regional Office and one copy on CD must be submitted to the Division of Waste
Minimization and Planning in Harrisburg. The CD version may be used for all other distribution at the
county's discretion. Expenses for this may be included in the "Supplies/Printing" budget category.
PART IV – PROJECT FINANCIAL DATA
A.
BUDGET CATEGORY DATA
1.
HHW Educational Costs associated with public education and/or advertising collection events.
These are costs associated to administration of HHW collection events.
2.
HHW Education Administration.
A maximum of 10% of the total project cost may consist of administration costs.
3.
Total Project Costs: Indicate the total project cost and the amount to be paid by the county
and by DEP. Total Project Cost is equal to all project costs required to complete the Scope of
Work. DEP Share cannot exceed 80% of the total project costs. Applicant Match cannot be
less than 20% of the total project costs.
B.
GRANT EXPENDITURE SCHEDULE
When completing the Grant Expenditure Schedule, estimate the percentage of the total DEP share costs
to be incurred in 6 month intervals from the time you receive the agreement for this grant (if awarded).
You will have an opportunity to adjust this schedule when the grant agreement is drafted. Not every
quarter must show an expenditure, but the total for all four quarters must equal 100%. Please use whole
numbers.
C.
RELATED FINANCIAL INFORMATION
Please answer questions 1, 2 and 3. If the question is not applicable to your project, please indicate—do
not leave the question blank.
PART V – TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION (FORM W-9)
Please complete the form provided. You cannot be awarded a grant unless this form is complete and
accurate.
Please use the County's Taxpayer Identification Number Only.
PART VI – SUPPORTING DOCUMENTS
Please attach any supporting documents (bids, quotes, drafts, HHW educational items, etc.) to your
application as needed.

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 3 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
Application B: For HHW Education
PART I - APPLICANT INFORMATION
PLEASE FOLLOW ALL INSTRUCTIONS AS PROVIDED
A.
APPLICANT:
BUSINESS ADDRESS:
STREET:
CITY:
PA
ZIP:
B.
CONTACT PERSON:
MR.
MS.
C.
TELEPHONE NUMBER: (
)
FAX NUMBER: (
)
D.
CONTACT PERSON EMAIL ADDRESS:
E.
ADDRESS OF CONTACT PERSON IF DIFFERENT FROM ABOVE:
STREET:
CITY:
PA
ZIP:
F.
DATE OF PRE-APPLICATION MEETING WITH DEP COORDINATOR:
Month
Day
Year
STATEMENT AND VERIFICATION
The above information is true and correct to the best of my personal knowledge or information and belief.
This statement and verification is made subject to the penalties of 18 Pa. C.S.A. § 4904 relating to unsworn
falsification to authorities, which provides that if I make knowingly false averments, I may be subject to
criminal penalties.
Signature of Elected/Appointed Municipal Official
Title
Date

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 4 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART II – PROJECT SUMMARY AND JUSTIFICATION

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 5 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
1. HHW EDUCATION

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 6 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART III – SCOPE OF WORK
2. HHW EDUCATION ADMINISTRATION

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 7 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART IV – PROJECT FINANCIAL DATA
Using the Project Scope of Work and the application instructions, complete the following table:
A.
BUDGET CATEGORY DATA
BUDGET ITEM
TOTAL
ITEM
COST
DEP SHARE
APPLICANT
MATCH
1.
EDUCATION
2.
HHW EDUCATION ADMINISTRATION*
3.
TOTAL PROJECT COSTS
*Maximum of 10% of Total Project Costs
B.
GRANT EXPENDITURE SCHEDULE
1.
What percentage of the total DEP share costs do you anticipate incurring during the
first 6 months after receiving your grant agreement?
%
2.
What additional percentage of the total DEP share costs do you anticipate incurring
during the following 12 months after receiving your grant agreement?
%
3.
What additional percentage of the total DEP share costs do you anticipate incurring
during the following 18 months after receiving your grant agreement?
%
4.
What additional percentage of the total DEP share costs do you anticipate incurring
during the following 24 months after receiving your grant agreement?
%
Total
100%

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 8 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART IV – PROJECT FINANCIAL DATA (CONTINUED)
C.
RELATED FINANCIAL INFORMATION
N/A
1.
Describe the nature of the match indicated in Part IV A. If any portion of this match is to be in-kind services,
indicate the manner in which the value of these services were determined:
N/A
2.
Indicate the names of consulting firms and/or subcontractors, if known, that will be utilized in the completion
of the project and the manner in which they were chosen. Indicate how costs for their services were
established:

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 9 -
N/A
3.
Describe the HHW educational items that will be developed and utilized to advertise collection events:

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 10 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART V – TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION – Form W-9

2520-FM-BWM0013.2
Rev. 10/2015
Application B
- 11 -
APPLICATION NUMBER
DEPARTMENT USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
DIVISION OF WASTE MINIMIZATION AND PLANNING
PART VI – SUPPORTING DOCUMENTS

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