Submitters are invited to download this form and fill it out on their computers. At this time, we are only accepting paper copies made using this form. You will need to send us 3 copies of the full PMN and , if it contains any confidential information, a fourth copy from which all confidential information has been removed. The e-PMN Form was developed with an intent that the Agency will receive PMNs in an electronic format. In the near future, we intend to develop the procedures to accept compact disks containg the e-PMN Form.
For trouble-shooting assistance in filling out and using the form,contact the CDX Help Desk by e-mail at epacdx@csc.com and by phone at 888-890-1995. Agency contacts to discuss Form development are Anna Coutlakis on 202-564-9207 and Dave Schutz on 202-564-9262.