Request Technical Assistance

Request Technical Assistance

Community Change Grants Technical Assistance Request Form

OMB Control No: 2030-0051
Expiration Date: 04/30/2024

This form is to express interest in receiving technical assistance (TA) for the EPA Environmental and Climate Justice Program’s Community Change Grants. 

To request TA for preparing a Community Change Grant application, please fill out this form or call 1 (800) 540-8123 if you have any questions or need help in filling out the form.

Receiving TA does not guarantee that you will receive funding under any EPA program or other program. If you have any questions or concerns about this form, please contact: EJ_TechAssist@epa.gov.

What type of organization do you represent? (select one)
Do you intend to apply for a Community Change Grant?
Do you have, or intend to enter into, a partnership with other eligible entities to apply for a Community Change Grant?
Community Change Grants must benefit a disadvantaged community. Please review the definition of disadvantaged communities in the Notice of Funding Opportunity and identify the disadvantaged community that the grant application you plan to submit is intended to benefit.
State/Province
What type of PROJECT do you need technical assistance with? (please check all that apply)
What type of technical assistance do you need to support your Community Change Grant project? (please check all that apply)
This includes TA with developing, preparing, and submitting a grant application and addressing eligibility issues
This includes TA with preparing project maps/designs, permitting and site control, determining project feasibility and readiness, developing project budgets, schedules, and implementation plans as well as obtaining specific subject matter expertise and relevant data (e.g., hydrology, landscape architecture, flood mitigation, sustainable buildings)
This includes TA support in conducting community outreach and developing community engagement plans
This includes TA support in developing partnerships and governance structures.

Burden Statement:

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. OMB Control No. 2030-0051. Responses to this collection of information are voluntary. 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. The public reporting and recordkeeping burden for this collection of information is estimated to be 4 minutes per response. 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. 

EPA Form: 5800-089