The filing forms contain embedded cross references to reduce the amount of repetition in the form fields. The data you enter into the fields of the Proposed Coversheet should automatically filter through the forms where data is expected to remain the same (title, agency name etc.) If you have difficulty, please contact the Office of the Secretary of State at 802-828-3700 or by email at SOS.StatutoryFilings@vermont.gov for assistance.

Submit only the coversheet and forms relevant to the current stage of filing (remove those coversheets not relevant to prevent confusion). If you are uncertain which forms are required for each step in the process, please see: https://sos.vermont.gov/secretary-of-state-services/apa-rules/filing-tools/rules-at-a-glance/.

The Secretary of State will accept electronic delivery of filings if all of the following conditions have been met:

Full name of person who signed the original form is typed in this format: /s/ Name of Person;

The filing forms, texts, and other enclosures are saved as PDF files.

The PDF files are sent as attachments in an email to sos.statutoryfilings@vermont.gov

The form with the original signature of the adopting authority is retained by the adopting authority as required by statute [3 V.S.A. § 843(e)].

The Secretary of State will continue to accept paper filings provided they bear the original signature of the adopting authority.

Filing forms are available for download from the Office of the Secretary of State’s website.

Please do not include this page with your filings. It is for your convenience only.

Emergency Filing - Coversheet

Instructions:

In accordance with Title 3 Chapter 25 of the Vermont Statutes Annotated and the “Rule on Rulemaking” (CVR 04-000-001) adopted by the Office of the Secretary of State, this emergency filing will be considered complete upon filing and acceptance of these forms with the Office of the Secretary of State, the Legislative Committee on Administrative Rules and a copy with the Chair of the Interagency Committee on Administrative Rules.

All forms shall be submitted to the Office of the Secretary of State, no later than 3:30 pm on the last scheduled day of the work week.

The data provided in text areas of these forms will be used to generate a notice of rulemaking in the portal of “Proposed Rule Postings” online, and the newspapers of record if the rule is marked for publication. Publication of notices will be charged back to the promulgating agency.

This emergency rule may remain in effect for a total of 180 days from the date it first takes effect.

Certification Statement: As the adopting Authority of this rule (see 3 V.S.A. § 801(b)(11) for a definition), I believe there exists an imminent peril to public health, safety or welfare, requiring the adoption of this emergency rule.

The nature of the peril is as follows (Please use additional sheets if space is insufficient).

I approve the contents of this filing entitled:

, on
(signature)	(date)

Printed Name and Title:

TITLE OF RULE FILING:

ADOPTING AGENCY:

PRIMARY CONTACT PERSON:

(a person who is able to answer questions about the content of the rule).

Name:

Agency:

Mailing Address:

Telephone: Fax:

E-Mail:

Web URL(where the rule will be posted):

SECONDARY CONTACT PERSON:

(A specific person from whom copies of filings may be requested or who may answer questions about forms submitted for filing if different from the Primary Contact Person).

Name:

Agency:

Mailing Address:

Telephone: Fax:

E-Mail:

RECORDS EXEMPTION INCLUDED WITHIN RULE:

(does the rule contain any provision designating information as confidential; limiting its public release; or otherwise exempting it from inspection and copying?)

IF YES, CITE THE STATUTORY AUTHORITY FOR THE EXEMPTION:

PLEASE SUMMARIZE THE REASON FOR THE EXEMPTION:

LEGAL AUTHORITY / ENABLING LEGISLATION:

(The specific statutory or legal citation from session law indicating who the adopting Entity is and thus who the signatory should be. THIS SHOULD BE A SPECIFIC CITATION NOT A CHAPTER CITATION).

EXPLANATION OF HOW THE RULE IS WITHIN THE AUTHORITY OF THE AGENCY:

CONCISE SUMMARY (150 words or Less):

EXPLANATION OF WHY THE RULE IS NECESSARY:

EXPLANATION OF HOW THE RULE IS NOT ARBITRARY AS DEFINED IN 3 V.S.A. § 801(b)(13(A):

LIST OF PEOPLE, ENTERPRISES AND GOVERNMENT ENTITIES AFFECTED BY THIS RULE:

BRIEF SUMMARY OF ECONOMIC IMPACT (150 words or Less):

A HEARING .

HEARING INFORMATION

(The first hearing shall be no sooner than 30 days following the posting of notices online).

If this form is insufficient to list the information for each hearing please attach a separate sheet to complete the hearing information needed for the notice of rulemaking.

Date:

Time:

Street Address:

Zip Code:

URL for Virtual:

Date:

Time:

Street Address:

Zip Code:

URL for Virtual:

DEADLINE FOR COMMENT (no earlier than 7 days following last hearing):

EMERGENCY RULE EFFECTIVE:

EMERGENCY RULE WILL REMAIN IN EFFECT UNTIL
(a date no later than 180 days following adoption of this emergency rule):

NOTICE OF THIS EMERGENCY RULE BE PUBLISHED IN THE WEEKLY NOTICES OF RULEMAKING IN THE NEWSPAPERS OF RECORD.

KEYWORDS (please provide at least 3 keywords or phrases to aid in the searchability of the rule notice online).

Adopting Page

Instructions:

This form must accompany each filing made during the rulemaking process:

Note: To satisfy the requirement for an annotated text, an agency must submit the entire rule in annotated form with proposed and final proposed filings. Filing an annotated paragraph or page of a larger rule is not sufficient. Annotation must clearly show the changes to the rule.

When possible the agency shall file the annotated text, using the appropriate page or pages from the Code of Vermont Rules as a basis for the annotated version. New rules need not be accompanied by an annotated text.

TITLE OF RULE FILING:

ADOPTING AGENCY:

TYPE OF FILING (Please choose the type of filing from the dropdown menu based on the definitions provided below):

AMENDMENT - Any change to an already existing rule, even if it is a complete rewrite of the rule, it is considered an amendment as long as the rule is replaced with other text.

NEW RULE - A rule that did not previously exist even under a different name.

REPEAL - The removal of a rule in its entirety, without replacing it with other text.

This filing is .

LAST ADOPTED (please provide the SOS Log#, title and Effective date of the Last adoption for the existing rule):

Economic Impact Analysis

Instructions:

In completing the economic impact analysis, an agency analyzes and evaluates the anticipated costs and benefits to be expected from adoption of the rule; estimates the costs and benefits for each category of people enterprises and government entities affected by the rule; compares alternatives to adopting the rule; and explains their analysis concluding that rulemaking is the most appropriate method of achieving the regulatory purpose. If no impacts are anticipated, please specify “No impact anticipated” in the field.

Rules affecting or regulating schools or school districts must include cost implications to local school districts and taxpayers in the impact statement, a clear statement of associated costs, and consideration of alternatives to the rule to reduce or ameliorate costs to local school districts while still achieving the objectives of the rule (see 3 V.S.A. § 832b for details).

Rules affecting small businesses (excluding impacts incidental to the purchase and payment of goods and services by the State or an agency thereof), must include ways that a business can reduce the cost or burden of compliance or an explanation of why the agency determines that such evaluation isn’t appropriate, and an evaluation of creative, innovative or flexible methods of compliance that would not significantly impair the effectiveness of the rule or increase the risk to the health, safety, or welfare of the public or those affected by the rule.

TITLE OF RULE FILING:

ADOPTING AGENCY:

CATEGORY OF AFFECTED PARTIES:

list categories of people, enterprises, and governmental entities potentially affected by the adoption of this rule and the estimated costs and benefits anticipated:

IMPACT ON SCHOOLS:

indicate any impact that the rule will have on public education, public schools, local school districts and/or taxpayers clearly stating any associated costs:

ALTERNATIVES: Consideration of alternatives to the rule to reduce or ameliorate costs to local school districts while still achieving the objective of the rule.

IMPACT ON SMALL BUSINESSES:

indicate any impact that the rule will have on Small Businesses (excluding impacts incidental to the purchase and payment of goods and services by the State or an Agency thereof):

SMALL BUSINESS COMPLIANCE: Explain ways a business can reduce the cost/burden of compliance or an explanation of why the agency determines that such evaluation isn’t appropriate.

COMPARISON:

compare the impact of the rule with the economic impact of other alternatives to the rule, including no rule on the subject or a rule having separate requirements for small business:

SUFFICIENCY: Describe how the analysis was conducted, identifying relevant internal and/or external sources of information used.

Environmental Impact Analysis

Instructions:

In completing the environmental impact analysis, an agency analyzes and evaluates the anticipated environmental impacts (positive or negative) to be expected from adoption of the rule; compares alternatives to adopting the rule; explains the sufficiency of the environmental impact analysis. If no impacts are anticipated, please specify “No impact anticipated” in the field.

Examples of Environmental Impacts include but are not limited to:

Impacts on the emission of greenhouse gases

Impacts on the discharge of pollutants to water

Impacts on the arability of land

Impacts on the climate

Impacts on the flow of water

Impacts on recreation

Or other environmental impacts

TITLE OF RULE FILING:

ADOPTING AGENCY:

GREENHOUSE GAS: explain how the rule impacts the emission of greenhouse gases (e.g. transportation of people or goods; building infrastructure; land use and development, waste generation, etc.):

WATER: explain how the rule impacts water (e.g. discharge / elimination of pollution into Vermont waters, the flow of water in the state, water quality etc.):

LAND: explain how the rule impacts land (e.g. impacts on forestry, agriculture etc.):

RECREATION: explain how the rule impacts recreation in the state:

CLIMATE: explain how the rule impacts the climate in the state:

OTHER: explain how the rule impact other aspects of Vermont’s environment:

SUFFICIENCY: Describe how the analysis was conducted, identifying relevant internal and/or external sources of information used.

Public Input Maximization Plan

Instructions:

Agencies are encouraged to hold hearings as part of their strategy to maximize the involvement of the public in the development of rules. Please complete the form below by describing the agency’s strategy for maximizing public input (what it did do, or will do to maximize the involvement of the public).

This form must accompany each filing made during the rulemaking process:

TITLE OF RULE FILING:

ADOPTING AGENCY:

PLEASE DESCRIBE THE AGENCY’S STRATEGY TO MAXIMIZE PUBLIC INVOLVEMENT IN THE DEVELOPMENT OF THE PROPOSED RULE, LISTING THE STEPS THAT HAVE BEEN OR WILL BE TAKEN TO COMPLY WITH THAT STRATEGY:

BEYOND GENERAL ADVERTISEMENTS, PLEASE LIST THE PEOPLE AND ORGANIZATIONS THAT HAVE BEEN OR WILL BE INVOLVED IN THE DEVELOPMENT OF THE PROPOSED RULE:

Scientific Information Statement

THIS FORM IS ONLY REQUIRED IF THE RULE RELIES ON SCIENTIFIC INFORMATION FOR ITS VALIDITY.

PLEASE REMOVE THIS FORM PRIOR TO DELIVERY IF IT DOES NOT APPLY TO THIS RULE FILING:

Instructions:

In completing the Scientific Information Statement, an agency shall provide a summary of the scientific information including reference to any scientific studies upon which the proposed rule is based, for the purpose of validity.

TITLE OF RULE FILING:

ADOPTING AGENCY:

BRIEF EXPLANATION OF SCIENTIFIC INFORMATION:

CITATION OF SOURCE DOCUMENTATION OF SCIENTIFIC INFORMATION:

INSTRUCTIONS ON HOW TO OBTAIN COPIES OF THE SOURCE DOCUMENTS OF THE SCIENTIFIC INFORMATION FROM THE AGENCY OR OTHER PUBLISHING ENTITY:

Incorporation by Reference

THIS FORM IS ONLY REQUIRED WHEN INCORPORATING MATERIALS BY REFERENCE. PLEASE REMOVE PRIOR TO DELIVERY IF IT
DOES NOT APPLY TO THIS RULE FILING:

Instructions:

In completing the incorporation by reference statement, an agency describes any materials that are incorporated into the rule by reference and how to obtain copies.

This form is only required when a rule incorporates materials by referencing another source without reproducing the text within the rule itself (e.g. federal or national standards, or regulations).

Incorporated materials will be maintained and available for inspection by the Agency.

TITLE OF RULE FILING:

ADOPTING AGENCY:

DESCRIPTION (describe the materials incorporated by reference):

FORMAL CITATION OF MATERIALS INCORPORATED BY REFERENCE:

OBTAINING COPIES: explain where the public may obtain the material(s) in written or electronic form, and at what cost):

MODIFICATIONS (Please explain any modification to the incorporated materials e.g., whether only part of the material is adopted and if so, which part(s)are modified):

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