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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 Remediation Agreement
Attachment 2 Bid Cost Spreadsheet
Attachment 3a Final SCR dated October 2018
Attachment 3b PADEP SCR Approval Letter March 2019
Attachment 3c RAP May 2019
Attachment 3d PADEP RAP Approval Letter June 2019
Attachment 3e Abbreviated SCR May 2020
Attachment 3f PADEP SCR Approval Letter Sept 2020
Attachment 3g Right of Entry Agreement Information
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