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3900PMBSDW0077D Rev. 5/2019 Module 19 InstructionsCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF SAFE DRINKING WATERDate Prepared Date RevisedPUBLIC WATER SUPPLY MODULE

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Start by gathering all necessary materials such as the application form, identification documents, and any supporting documents.

02

Fill out the application form completely and accurately, making sure to provide all requested information.

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Submit the completed application form along with any required documents to the designated program office or online portal.

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If approved for the safe drinking water program, follow any additional instructions provided by the program office to begin receiving benefits.

Who needs safe drinking water program?

01

Individuals and families who do not have access to safe and clean drinking water.

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Communities or regions where the water supply is contaminated or unreliable.

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People who are at higher risk of waterborne illnesses, such as children, pregnant women, and individuals with weakened immune systems.

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What is safe drinking water program?

Safe drinking water program ensures that the water provided to the public meets health-based standards and is safe to drink.

Who is required to file safe drinking water program?

Public water systems are required to file safe drinking water program.

How to fill out safe drinking water program?

To fill out safe drinking water program, water systems need to provide information on water sources, treatment processes, monitoring results, and compliance with regulations.

What is the purpose of safe drinking water program?

The purpose of safe drinking water program is to protect public health by ensuring the safety and quality of drinking water.

What information must be reported on safe drinking water program?

Information such as water sources, treatment processes, monitoring results, and compliance with regulations must be reported on safe drinking water program.

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