Free Occupational Lead Poisoning Prevention Fee Return for Category A or B Reporting - California

BOE-501-LA (FRONT) REV. 13 (11-08)

OCCUPATIONAL LEAD POISONING PREVENTION FEE RETURN
FOR CATEGORY "A" OR "B" REPORTING
DUE ON OR BEFORE

BOARD OF EQUALIZATION

BOE USE ONLY
RA-B/A RR-QS AUD FILE REG REF

STATE OF CALIFORNIA


[ FOID

]


YOUR ACCOUNT NO. EFF

BOARD OF EQUALIZATION
ENVIRONMENTAL FEES DIVISION
P O BOX 942879
SACRAMENTO CA 94279-6029

READ INSTRUCTIONS
BEFORE PREPARING


All employers in industries for which there is evidence of a potential for lead poisoning are required to file the Occupational Lead
Poisoning Prevention Fee Return. This return is being sent to you because you were identified by the California Department of Public
Health (CDPH) as being in one of these industries.
SECTION I
Complete this section if you are requesting a fee waiver. Please note: A fee waiver application and instructions will be sent to you by the
CDPH after this return is received and processed by the Board of Equalization (BOE). The BOE does not mail fee waiver applications.
1a. I will request a fee waiver because lead or lead containing materials were not present or were present in a de minimus (minimal)
amount at any California site of my business operation during the calendar year. I understand that if I do not complete a waiver
application within 180 days following the due date of this return and/or if a waiver is not granted, the fee plus applicable
interest will be due. 1b. Check here if you have applied for a fee waiver before and only need a new application.
If you checked either box above, do the following: 2. Enter the total number of your employees at all California locations (see Definitions on the back of the form).
Sign and date this return and send it to the address above. Maintain a copy for your records. The filing of this return is required,
but it does not constitute a fee waiver request.
SECTION II
Complete this section if you are not requesting a fee waiver. The fee category (A or B) that is applicable to your business is shown above
with your SIC code.


A NUMBER OF EMPLOYEES DURING CALENDAR YEAR COVERED BY THIS RETURN

B AMOUNT OF FEE

C AMOUNT OF FEE DUE

Category A: (Complete only if you are in Category A) . 1. Less than 10 employees (if less than 10 employees, check box at right) 2. 10 to 99 employees 3. 100 to 499 employees 4. 500 or more employees Category B: (Complete only if you are in Category B) 5. Less than 10 employees (if less than 10 employees, check box at right) . 6. 10 to 99 employees 7. 100 to 499 employees 8. 500 or more employees 5. 6. 7. 8. 9. $ 10. $ 11. $ 12. $ $ 1. 2. 3. 4. $

9. Enter the total fee due (amount from line 2, 3, or 4 for Category A or line 6, 7, or 8 for Category B) 10. Penalty [multiply line 9 by 10% (0.10) if payment is made after the due date shown above] 11.
INTEREST: One month's interest is due on the total fee for each month or fraction of a month that payment is delayed after the due date. The adjusted monthly interest rate is PENALTY INTEREST

12. TOTAL AMOUNT DUE AND PAYABLE (add lines 9, 10, and 11)
IF PAID BY CREDIT CARD, CHECK HERE (Mandatory EFT accounts MUST pay by EFT).
I hereby certify that this return, including any accompanying schedules and statements, has been
examined by me and is, to the best of my knowledge and belief, a true, correct, and complete return.

PRINT NAME AND TITLE SIGNATURE TELEPHONE NUMBER


DATE


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)


Make check or money order payable to State Board of Equalization.

Always write your account number on your check or money order. Make a copy of this document for your records.


OL

CLEAR

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BOE-501-LA (BACK) REV. 13 (11-08)


OCCUPATIONAL LEAD POISONING PREVENTION FEE RETURN INSTRUCTIONS

GENERAL INFORMATION
Section 105190 of the California Health and Safety Code requires all employers with 10 or more employees in an industry for which there is
evidence of a potential for occupational lead poisoning to pay the Occupational Lead Poisoning Fee. Those employers who do not have lead or
lead-containing materials present in any amount or who only have a de minimus (minimal) amount in their business operations may request a fee
waiver which, if granted, will relieve them of paying a fee for the calendar year. The waiver must be renewed each year. Employers with 10 or
more employees not requesting a waiver are subject to the fee. These fees are used to fund the Occupational Lead Poisoning Prevention
Program in the California Department of Public Health (CDPH).
Each year CDPH provides the Board of Equalization (BOE) with a list of industries which CDPH has determined have the potential for
occupational lead poisoning. The industries are designated by Standard Industrial Classification (SIC) code. CDPH also provides the BOE with a
list of employers whose business operations fall within the listed industries.
DEFINITIONS (According to section 38001 of title 17 of the California Code of Regulations)
Employee means any individual employed for at least 160 hours in the prior calendar year (during the reporting period shown on the front of this
return), regardless of whether the individual's specific job involved potential exposure to lead or lead-containing materials.
Standard Industrial Classification (SIC) code means a system of four-digit numerical codes to designate the activities of a business operation, set
forth by the U.S. Office of Management and Budget in the Standard Industrial Classification Manual, 1987.
Lead was not present at the place of employment means that no amount of lead or lead-containing material was present at the place of
employment or in the materials and processes used in the operation of the employer's business, with the following exceptions:
(1) Lead that was not altered or disturbed during the operation of the employer's business and was present in a form, or contained in such a
manner, that it could not be inhaled or ingested (examples are undisturbed building materials, unused materials and supplies, intact lead
storage batteries); or
(2) Lead present as a result of general environmental contamination which was not the result of the operation of the employer's business.
De minimus amount means any of the following:
(1)
Lead present in materials which are altered or disturbed and have a lead concentration less than 0.5 percent (5,000 ppm) by weight;
(2) Lead present in materials where the total weight of such materials altered or disturbed during the calendar year is known to be
16 ounces (one pound) or less by weight; or
(3)
Lead present in materials where no such material is altered or disturbed at any individual employee's place of employment on more
than one day during the calendar year (that is, if no employee works on more than one day during the calendar year in any location
where lead-containing materials are being altered or disturbed, then the amount is de minimus).
PAYMENTS
Check or money order should be made payable to the State Board of Equalization.
Credit card payments can be made with Discover/Novus, MasterCard, VISA, or American Express. Other credit cards cannot be
accepted. EFT accounts are not eligible for credit card payments. Credit card payments can be made by calling 800-272-9829 or
through our website at www.boe.ca.gov. Click on the eServices tab and select credit card payments. After authorizing your payment,
check the box on your return indicating you have paid with a credit card. Be sure to sign and mail your return.
Electronic Funds Transfer (EFT) must be initiated on or before the due date of the return and the funds must be transferred into the
Board of Equalization bank account on the first banking day following the day the payment is initiated to be considered timely.
Please be advised that making your payment by EFT does not relieve you from the requirement to file your return by the due date.
If you are not registered to pay by EFT and would like to be, please contact us at 916-322-9534.
HOW TO FILE
Review the following information to determine which section on the front of the return you are required to complete.
SECTION I of this return is provided for employers to inform the BOE that no fee is required at this time because a fee waiver will be requested.
Only employers who do not have lead or lead-containing materials present or who only have a de minimus (minimal) amount present at any
California site qualify to claim a waiver. If you will be requesting a waiver, you should complete Section I and follow the instructions it contains. A
fee waiver application and instructions will be automatically sent to you by CDPH if you check the box in Section I. Employers that wish to
request a fee waiver must send their completed applications to the CDPH within 180 days of the due date of this return. For specific questions
regarding fee waivers contact the CDPH Occupational Lead Poisoning Prevention Program by calling toll-free (in California only) 866-627-1587,
or (out-of-state) 510-620-5740. The address is: California Department of Public Health, OLPPP, Attention: Fee Waiver Request, 850 Marina Bay
Parkway, Bldg. P, 3rd Floor, Richmond, CA 94804. Persons completing this section may file the return without payment. However, if a waiver
request and documentation are not submitted as required or a waiver is not granted, the fee is due. The BOE will bill you for any fee due, plus
interest at the statutory rate. Employers completing this section need not complete Section II.
SECTION II of this return is provided for employers to report and pay fees due. If you have a business operation described by a SIC code listed
in title 17 CCR section 38005 and you have not completed Section I, you are required to complete this section and pay the fee due. This section
shows the rates for both Category A and Category B reporting. The appropriate category for your business is shown on the front of the return
with your SIC code. If you have any questions about how to complete Section II, please contact us at 916-323-9555.
PREPARATION OF RETURN
Read Sections I and II on the front of the return and complete the section that is applicable to you. Complete the bottom line of the return and
mail to the Board of Equalization. Fee returns and payments that are mailed must be postmarked on or before the due date shown on the return.
If the due date falls on a Saturday, Sunday, or legal holiday, returns postmarked on the next business day are considered timely. Retain a copy
of the return for your records. Please refer to the account number at the top of your return on all correspondence.


If you wish additional information, please contact the State Board of Equalization, Environmental Fees Division,
PO Box 942879, Sacramento, CA 94279-0057, Telephone 916-323-9555.