An official website of the United States government.

This is not the current EPA website. To navigate to the current EPA website, please go to www.epa.gov. This website is historical material reflecting the EPA website as it existed on January 19, 2021. This website is no longer updated and links to external websites and some internal pages may not work. More information »

Payment Request Form for Grants and Cooperative Agreements

EPA Form 190-F-04-001 is used by non-ASAP participants to request payment via electronic funds transfer (EFT).

This form is availble below as a fillable, PDF form or here as a Microsoft Excel spreadsheet - Payment Request for Grants and Cooperative Agreements.xls(1 pg, 18 K) .

You may need a PDF reader to view some of the files on this page. See EPA’s About PDF page to learn more.

Payment Request Form for Grants and Cooperative Agreements (PDF)(1 pg, 38 K)