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JOSH SHAPIRO, Governor   |   Michael Humphreys, Commissioner

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For USTIF to process your claim in timely manner, please follow these instructions.

  1. Complete all the fields highlighted in yellow.
  2. Save a copy for your records, once completed.
  3. Email the form to RA-IN-FBSCLAIMS@PA.GOV with the subject line:
    CLAIM NOTIFICATION SUBMITTAL FORM

If you run into issues, please contact by calling 717-783-8093 and follow the prompts for Claims Department. Thank you.

Attachments

FINAL Contracts Entry Data List

Attachment 1 Bid Submission Coversheet
Attachment 2 Remediation Agreement
Attachment 3 Required Responses Submission Form
Attachment 4 Bid Cost Submission Form
Attachment 5a Figures 1 and 2
Attachment 5b UST Closure Report April 1996
Attachment 5c UST Closure Report September 2019
Attachment 5d SCR RAP December 2019
Attachment 5e PADEP Letter SCR RAP Disapproval March 2020
Attachment 5f SCR RAP August 2020_Part 1 of 2
Attachment 5f SCR RAP August 2020_Part 2 of 2
Attachment 5g PADEP Letter SCR RAP Approval October 2020
Attachment 5h 1st Quarter 2022 RAPR
Attachment 5i Surveyed Site Plan
Attachment 5j Historical Site Plan with Stormwater System
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