5700-55 Key Contacts Form for Multiple Principal Investigators

Form Approved OMB Control No. 2030-0020

KEY CONTACTS FORM FOR MULTIPLE PRINCIPAL
INVESTIGATORS
Authorized Representative: Original awards and amendments will be sent to this individual for review
and acceptance, unless otherwise indicated.
Name: __________________________________________________________________________
Title: ___________________________________________________________________________
Complete Address: ________________________________________________________________
________________________________________________________________
Phone Number: ___________________________________________________________________

Payee: Individual authorized to accept payments.
Name: __________________________________________________________________________
Title: ___________________________________________________________________________
Mail Address: ____________________________________________________________________
________________________________________________________________________________
Phone Number: ___________________________________________________________________

Administrative Contact: Individual from Sponsored Program Office to contact concerning
administrative matters (i.e., indirect cost rate computation, rebudgeting requests etc.)
Name: __________________________________________________________________________
Title: ___________________________________________________________________________
Mailing Address: __________________________________________________________________
________________________________________________________________________________
Phone Number: ___________________________________________________________________
FAX Number: ____________________________________________________________________
E-Mail Address: __________________________________________________________________

Contact Principal Investigator: Individual to whom Agency program officials will direct all
communications related to scientific, technical, and budgetary aspects of the project including pre-and postaward communications. This individual shares equal responsibility and accountability for the proper conduct
of the project or program with all other Principal Investigators.
Name: __________________________________________________________________________
Title: ___________________________________________________________________________
Mailing Address: __________________________________________________________________
________________________________________________________________________________
Phone Number: ___________________________________________________________________
FAX Number: ____________________________________________________________________
E-Mail Address: __________________________________________________________________
Web URL: _______________________________________________________________________

EPA Form 5700-55

Form Approved OMB Control No. 2030-0020

ADDITIONAL KEY CONTACTS FORM FOR MULTIPLE
PRINCIPAL INVESTIGATORS
(Use as many sheets as needed.)

Principal Investigator: This individual shares equal responsibility and accountability for the proper
conduct of the project or program with all other Principal Investigators.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

Principal Investigator: This individual shares equal responsibility and accountability for the proper
conduct of the project or program with all other Principal Investigators.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

Principal Investigator: This individual shares equal responsibility and accountability for the proper
conduct of the project or program with all other Principal Investigators.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

EPA Form 5700-55

Form Approved OMB Control No. 2030-0020

ADDITIONAL KEY CONTACTS FORM FOR MULTIPLE
PRINCIPAL INVESTIGATORS
(Use as many sheets as needed.)

Co-Investigator: Individual responsible for the completion of portions of the proposed work.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

Co-Investigator: Individual responsible for the completion of portions of the proposed work.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

Co-Investigator: Individual responsible for the completion of portions of the proposed work.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

EPA Form 5700-55

Paperwork Reduction Act Burden Statement
The public reporting and recordkeeping burden for this collection
of information is estimated to average 30 minutes per response.
Send comments on the Agency’s need for this information, the
accuracy of the provided burden estimate, and any suggested
methods for minimizing respondent burden, including through the
use of automated collection techniques, to the Director,
Collection Strategies Division, U.S. Environmental Protection
Agency (2822T), 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 5700-55