Form 5900-02 Service Provider Directory Contact Information Form

OMB Control Number: 2060-0722

Expiration Date: MM/DD/YYYY

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0722). 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 15 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.

Service Provider Directory Contact Information Form (Web Form)

This form should be completed by companies that are interested in being added to the Natural Gas STAR Service Provider Directory.

Field Name	Data Type	Required	Notes
First Name	Single Line of Text	Yes	First name of company point of contact
Last Name	Single Line of Text	Yes	Last name of company point of contact
Company/Org Name	Single Line of Text	Yes
Street Address	Single Line of Text	Yes
City	Single Line of Text	Yes
State	Single Line of Text	Yes
Zip/Postal Code	Single Line of Text	Yes
Country	Dropdown List	Yes
Email Address	Single Line of Text	Yes	Email address for company contact
Phone Number	Single Line of Text	Yes	Phone number for company contact
Website Address	Single Line of Text	No	Company/org website
Service Area	Multiselect	Yes	Area where services or technologies are available; state searchable
Service Area Description	Single Line of Text	No	Identify service area not listed
Service Area Other	Single Line of Text	No	States or regions of the US serviced by company; international service area
Services Description	Multiple Lines of Text	Yes
Service Category	Multiselect	Yes	Identify applicable service categories
Service Category Other	Single Line of Text	No	Identify service categories not listed
Emission Sources	Multiselect	Yes	Identify applicable sources to mitigate methane emissions from:
Emission Sources Other	Single Line of Text	No	Identify emission sources not listed
Emission Sources Description	Multiple Lines of Text	No	Provide additional relevant information about sources
Technology	Multiselect	No	Identify applicable technologies
Technology Other	Single Line of Text	No	Identify technologies not listed
Technology Description	Multiple Lines of Text	No	Provide additional relevant information about the technology
Instrument	Multiselect	No	Identify applicable instrument
Instrument Deployment Method	Multiselect	No	Identify applicable instrument category
Instrument Specifications	Multiple Lines of Text	No	Provide additional relevant information about the technology
Applicable Segments	Multiselect	Yes	Identify applicable sector(s)
Additional Supporting Information	Attachments or links	No	Provide relevant information or documentation about services, technologies or instruments.
Would You Like to Receive Email Updates?	Yes/No	Yes

NOTE: EPA created the Service Provider Directory to share information on service and technology providers that can facilitate methane emission reduction activities, not to endorse particular companies or products. Providing contact information and links to non-EPA websites does not constitute an endorsement by EPA or any of its employees. All user-submitted information is subject to the Freedom of Information Act.

EPA Form Number: 5900-502