6100-28 Proposed Annual Report Form

2026 MSGP

Appendix I – Annual Report Form

NOTE: EPA proposes the text in this Appendix as part of the Proposed 2026 MSGP.
Proposed Appendix I - Annual Report Form

D
R

AF

T

Part 7.2 requires you to use the NPDES eReporting Tool, or “NeT”, to prepare and submit your
Annual Report. However, if you are given a waiver by the EPA Regional Office to use a paper
annual report form,and you elect to use it, you must complete and submit the following form.

NPDES Form 6100-28

Page I-1 of 5

2026 MSGP

Appendix I – Annual Report Form
Instructions for Completing EPA Form 6100-28
Annual Report for Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit
This Form Replaces Form 6100-28 (03/21)

Who Must File an Annual Report
Operators must submit an Annual Report to EPA electronically, per
Part 7.4, by January 30th for each year of permit coverage containing
information generated from the past calendar year.
Completing the Form
To complete this form, type or print, using uppercase letters, in the
appropriate areas only. Please place each character between the
marks. Abbreviate if necessary to stay within the number of
characters allowed for each item. Use only one space for breaks
between words, but not for punctuation marks unless they are
needed to clarify your response. Please submit original document
with signature in ink - do not send a photocopied signature.

Section E. Certification Information
The Annual Report must be signed by a person described below,or
by a duly authorized representative of that person.
For a corporation: By a responsible corporate officer. For thepurpose
of this Section, a responsible corporate officer means:
(i) a president, secretary, treasurer, or vice-president of the
corporation in charge of a principal business function, or any other
person who performs similar policy- or decision-making functions for
the corporation, or (ii) the manager of one or more manufacturing,
production, or operating facilities, provided, the manager is
authorized to make management decisions which govern the
operation of the regulated facility including having the explicit or
implicit duty of making major capital investment recommendations,
and initiating and directing other comprehensive measures to
assure long-term environmental compliance with environmental
laws and regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete and
accurate information for permit application requirements; and
where authority to sign documents has been assigned or delegated
to the manager in accordance with corporate procedures.

T

Section A. Approval to Use Paper Annual Report Form

F o r m OMB No. 2040-NEW

D
R

AF

You must indicate whether you have been granted a waiver from
electronic reporting from the EPA Regional Office. Note that you are
not authorized to use this paper form unless the EPA Regional Office
has approved its use. Where you have obtained approval to use this
form, indicate the waiver that you have been granted, the name of
the EPA staff person who granted the waiver, and the date that
approval was provided. See https://www.epa.gov/npdes/contactFor a partnership or sole proprietorship: By a general partner or the
us-stormwater for a list of EPA Regional Office contacts.
proprietor, respectively; or
Section B. Permit Information
For a municipality, state, federal, or other public agency: By eithera
Provide the NPDES ID (i.e., NOI tracking number) assigned to your principal executive officer or ranking elected official. For purposes
facility.
of this Part, a principal executive officer of a federal agency includes
(i) the chief executive officer of the agency, or (ii) a senior executive
Section C. Facility Information
officer having responsibility for the overall operations of a principal
Enter the official or legal name, phone number, and complete street geographic unit of the agency (e.g., Regional Administrator of EPA).
address, including city, state, ZIP code, and county or similar Include the name and title of the person signing the form and the
government subdivision, for the facility that is covered by the NPDES date of signing.
ID identified in Section B. If the facility lacks a street address, indicate
A person is a duly authorized representative only if:
the general location of the facility (e.g., Intersection of State
Highways 61 and 34). Also provide a point of contact name for the
1. The authorization is made in writing by a person described
facility.
above;
Section D. General Findings

To complete this section you must provide the following information
in your annual report:
1.

A summary of your past year’s facility inspection
documentation, including inspection dates, required by Part
3.1.6 of the permit.

2. A summary of your past year’s quarterly visual assessment
documentation, including visual assessment dates, required
by Part 3.2.3 of the permit.

2. The authorization specifies either an individual or a position
having responsibility for the overall operation of the regulated
facility or activity such as the position of plant manager,
operator of a well or a well field, superintendent, position of
equivalent responsibility, or an individual or position having
overall responsibility for environmental matters for the
company, (A duly authorized representative may thus be
either a named individual or any individual occupying a
named position.) and
3. The written authorization is submitted to the Director.

3. Information copied or summarized from the corrective action An unsigned or undated Annual Report form will be considered
incomplete.
and/or additional implementation measures (AIM)
documentation required per Part 5.3 (if applicable). If
Paperwork Reduction Act Notice
corrective action and/or additional implementation
measures are not yet completed at the time of submission of This collection of information is approved by OMB under the
Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control
this Annual Report, you must describe the status of any
outstanding corrective action(s)/ additional implementation No. 2040-NEW). Responses to this collection of information are
mandatory (40 CFR 122.26). An agency may not conduct or
measures. You must also describe any incidents of
sponsor, and a person is not required to respond to, a collection
noncompliance in the past year or currently ongoing, or if
of information unless it displays a currently valid OMB control
none, provide a statement that you are in compliance with
number. The public reporting and recordkeeping burden for this
the permit.
collection of information is estimated to be 1 hour per response.
Send comments on the Agency’s need for this information, the
accuracy of the provided burden estimates and any suggested
methods for minimizing respondent burden to the Regulatory
Support Division Director, U.S. Environmental Protection Agency
(2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.
Include the OMB control number in any correspondence. Do not
send the completed form to this address.

NPDES Form 6100-28

Page I-4 of 5

2026 MSGP

Appendix I – Annual Report Form
Instructions for Completing EPA Form 6100-28
Annual Report for Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit
This Form Replaces Form 6100-28 (03/21)

F o r m OMB No. 2040-NEW

Submitting Your Form

For Overnight/Express Mail Delivery:

If you have been granted a waiver from your Regional Office to
submit a paper Annual Report form, you must send your Annual
Report form by mail to one of the following addresses:

Stormwater Notice Processing Center
William Jefferson Clinton East Building - Room 7420
ATTN: 2026 MSGP Reports
U.S. EPA
1201 Constitution Avenue, NW
Washington, DC 20004

For Regular U.S. Mail Delivery:

Visit this website for instructions on how to submit electronically:
https://www.epa.gov/npdes/stormwater-discharges-industrialactivities-ereporting

D
R

AF

T

Stormwater Notice Processing Center
Mail Code 4203M, ATTN: 2026 MSGP Reports
U.S. EPA
1200 Pennsylvania Avenue, NW
Washington, DC 20460

NPDES Form 6100-28

Page I-5 of 5