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Choose Your Requests

Choose your requests - select all that apply(Required)

You will be required to upload a copy of your IRS W-9 form - Request for Taxpayer Identification Number and Certification, later in this form.

Facility Information

Have you received an invoice for this facility?(Required)
Have you paid the referenced invoice?(Required)
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    Facility address(Required)
    Please format as 12-1234567

    Contact Information

    Contact name(Required)

    Invoice Information Correction

    Complete this section if the facility or billing name / address appearing on your MassDEP invoice is incorrect. See the sample invoice below.

    Please be advised that MassDEP may require additional information or program-specific notifications/documentation to reflect any changes to permits, certifications, registrations, etc. (e.g., to update an EPA ID, you must submit a notification through the Federal RCRAInfo website).

    Please contact the MassDEP program(s) associated with your permit(s) for additional information on permit deactivation/updates: MassDEP Program Contacts.

    Select any items that need correcting(Required)

    You will be required to upload a copy of your IRS W-9 form - Request for Taxpayer Identification Number and Certification, later in this form

    Is this an ownership change - the ownership FEIN is changing OR a name change ONLY - the ownership FEIN is remaining the same?(Required)
    Is the billing address the same as the facility's physical address?
    Correct address - billing and physical address is the same(Required)
    Correct billing address(Required)
    Correct billing address(Required)
    Correct physical address of the facility(Required)
    Correct physical address of the facility(Required)
    Effective date of the above change(s)(Required)
    Will you pay on the invoice as is or do you need the corrected version of the invoice printed and sent to you before you can pay?(Required)

    Permit, Certification, and or Registration Deactivation

    Please be advised that, this notification does NOT constitute a permit, certification and or registration deactivation. To complete permit, certification and or registration deactivation, additional information or program-specific notifications or documentation may be required (e.g., to deactivate an EPA ID, you must submit a notification through the Federal RCRAInfo website). Please contact the MassDEP program(s) associated with your permit(s) for additional information on permit deactivation/updates: MassDEP Program Contacts.

    Business Closure

    Business closure - The permit categories listed under “Description” on the front of your invoice represent the formal status of your permit(s) in the records of the Department at the beginning of the Fiscal Year (July 1 or Sept 15 for the ERP Dry Cleaner, Photo Processor, or Printer Program). You are responsible for surrendering your permit in writing to the Department on or before June 30 or submitting an ERP statement of non-applicability on or before September 14 to be exempt from an annual compliance fee for that fiscal year.

    Please be advised that MassDEP may require additional information or program-specific notifications or documentation to reflect any changes to permits, certifications, registrations, etc. (e.g., to deactivate an EPA ID, you must submit a notification through the Federal RCRAInfo website). Please contact the MassDEP program(s) associated with your permit(s) for additional information on permit deactivation/updates: MassDEP Program Contacts.

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      Effective date of the above change(s)(Required)
      Check here if the facility notified MassDEP that it closed prior to July 1

      You will be required to fill out the Fee Review Request section later in this form.

      Ownership Change

      Please be advised that the MassDEP may require additional information or program-specific notifications/documentation to reflect any changes to permits, certifications, registrations, etc. (e.g., to update an EPA ID, you must submit a notification through the Federal RCRAInfo website). Please contact the MassDEP program(s) associated with your permit(s) for additional information on permit deactivation/updates: MassDEP Program Contacts.

      New owner is a(Required)
      Name of new owner(Required)
      New facility contact name - optional
      Effective date of the above change(s)(Required)
      Check here if the facility notified MassDEP that it changed ownership prior to July 1

      You will be required to fill out the Invoice Review Request section later in this form.

      Will you pay on the invoice as is or do you need the corrected version of the invoice printed and sent to you before you can pay?(Required)

      Fee Review Request

      If you surrendered your permit, registration, and or certification in writing to the Department on or before June 30 or submitted an ERP Dry Cleaner, Photo Processor, or Printer statement of non-applicability on or before September 14, you do not owe the fee for that year and should complete the form for a fee review request. 

      If your facility has not formally surrendered your permit, registration, and or certification to MassDEP in writing, then you owe the invoiced amount to the Commonwealth of Massachusetts and should promptly deactivate all relevant permits, registrations, and or certifications to avoid being invoiced in the future.

      Complete this section if you believe your facility was billed incorrectly. NOTE: All requests must be filed on or before the due date on the front of the original invoice.

      Reason for fee review request(Required)
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        Has your facility deactivated all permits, registrations, and or certifications? E.g., deactivated EPA ID by submitting notification through the RCRAInfo website. Note: completing the Permit Deactivation section of this form does NOT complete the deactivation process and will require additional contact with MassDEP.(Required)

        MassDEP will contact you to provide additional guidance on deactivating your permits, registrations, and or certifications as necessary. 

        All review requests must be accompanied by payment in full of the amount of the fee due for the category you assert is appropriate.

        Effective date of closure(Required)
        Please explain the reason that you believe the permit fee category change is appropriate.

        Hardship Request

        Complete this section if you have suffered a severe financial hardship and would like to request a payment plan for your bill. 

        NOTE: All requests must be filed on or before the due date on the front of the original invoice.

        Please explain the specific circumstances you believe constitute severe financial hardship. Include a proposed payment plan schedule for making payment and any additional comments below.
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        Max. file size: 50 MB.

          Send My Invoice

          Facility physical address(Required)
          Mailing address is the same(Required)
          Mailing address(Required)

          Upload IRS W-9 Form

          Based on your request, MassDEP requires a copy of your IRS W-9 form - Request for Taxpayer Identification Number and Certification.

          Drop files here or
          Max. file size: 50 MB.

            Attestation

            Attestation(Required)
            Name(Required)
            Date(Required)