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Lead

EPA New England Lead-Based Paint Disclosure Rule Tip/Complaint Form

All questions, tips or complaints about lead in drinking water should be directed to the Safe Drinking Water Hotline.

Directions: Complete as much as possible.

This form is for alleged violations in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.

For alleged violations in a U.S. state not listed above, contact EPA using our Report Environmental Violations page.

1.

(a.) Name, Address, and Telephone Number of Alleged Violator(s)

Title (Required)

Name (Required)

Street (Required)

City (Required)

State (Required)

Click for alleged violations occurring in a U.S. state not listed here.

Zip Code (Required)

Phone (Required)

Alternate Phone

Did the sale or rental involve a Seller's Agent or Lessor's Agent?

Yes

Unknown

Agent Name

Street

City

State

Zip Code

Phone

Alternate Phone

(b.) Address of Sale or Rental Property

Street

City

State

Zip Code

Phone

(c.) Your Name, Address, and Telephone Number

You are a

if other

Name

Street

City

State

Zip Code

Phone

Alternate Phone

E-mail

2. General Information

(a.) Was the residence built before 1978 (Required)

Yes

Unknown

(b.) Do children currently live in the residence? (Required)

Yes

Unknown

(c.) If yes, what are their ages?

(d.) Are there children with elevated blood lead levels at this address? (Required)

Yes

Unknown

(e.) Type of Housing (Required)

if other

3. Sales Transaction

Date of the Purchase & Sale Agreement (i.e., date the Buyer became obligated to purchase the property)

Month

Day

Year

4. Rental Transaction

(a.) Is the lease agreement written or unwritten?

Written

Unwritten

(b.) Date of Initial Lease

Month

Day

Year

(c.) How long has the Tenant resided in the unit?

(d.) How many units are in the Tenant's building? (Required)

(e.) Number of pre-1978 residential units owned by Lessor or managed by Agent

5. Lead Disclosure

(a.) Did the Buyer/Tenant receive any information about lead-based paint/lead-based paint hazards? (Required)

Yes

Unknown

(b.) Did the Buyer/Tenant receive an EPA-approved lead hazard information pamphlet? (Required)

Yes

Unknown

6. Comments

More information helps EPA respond more effectively. Please include all of the relevant details you may have.

Leave this field blank