TEMPLATE FOR
DOT EPLS Submission |
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OA Check appropriate agency:
FAA________ FHWA_______ FMCSA ________ FRA_______ FTA______
MARAD_____ NHTSA_______ OST_____ PHMSA________ RITA_______
For each EPLS Submission request, please complete the following information:
Name:
Address:
DUNS#:
Cause and Treatment Code: (See http://epls.gov/)
Action Date:
Term Date
Please send this form electronically to: Ellen.Shields@dot.gov. |