ENTITY Form 17-12
PREPARED BY REVIEWED BY
REVISION DATE SECTION PAGE
Please list the various regulatory agencies having a significant impact on the entity’s operations and/or costs.
NATURE OF IMPACT POTENTIAL FUTURE IMPACT
Example: EPA Air quality. Cost of scrubbers, higher cost
Note: (1) List as appropriate: Equal Employment Opportunity Commission (EEOC), Environmental Protection
Agency (EPA), Federal Communications Commission (FCC), Food and Drug Administration (FDA),
Occupational Safety and Health Administration (OSHA), etc.