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Instructions for completing this form:
- Enter the required information in the appropriate sections.
- Press the Submit button once done.
- You will receive an Adobe file (PDF file) which you will need to save.
- After the form has been printed, it must be signed and dated by an authorized individual.
- Deliver the signed PDF form to the Regulations Division.
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NOTE: Entry boxes are sized to fit the printed report. If what is typed does not fit in the box, it will be truncated when printed.
To see if what was entered will fit, select the Preview Format button.
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Invalid Chapter Number
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Invalid Chapter Title
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(Required for Department of Transitional Assistance; otherwise not required.)
Invalid State Letter
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State the general requirements and purposes of this regulation.
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Invalid Summary
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Invalid Regulation Authority
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Invalid Agency Address
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Compliance with M.G.L. c. 30A
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If this regulation is adopted as an emergency, state the nature of the
emergency. If this is not an emergency filing, please leave this area blank.
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Invalid Emergency Adoption
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If prior notification to and/or approval of the Governor, Legislature or others
was required, list each notification, and/or approval and date, including notice to the Local
Government Advisory Commission.
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Invalid Prior Notification
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M.G.L. c. 30A section 2 and/or 3 requires notice of the hearing
or comment period, including a small business impact statement, be filed with the
Secretary of the Commonwealth, published in appropriate newspapers, and sent to
persons to whom specific notice must be given at least 21 days prior to such hearing
or comment period.
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Invalid Date of Public Hearing
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Estimate the fiscal effect on the public and private sectors
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Invalid Fiscal Effect First Year
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Invalid Fiscal Effect First Five Years
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Invalid No Fiscal Effect
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M.G.L. c. 30A section 5 requires each
agency to file an amended small business impact statement with the Secretary of the Commonwealth prior to
the adoption of a proposed regulation. Note: If the purpose of this regulation is
to set rates for the state, this section does not apply.
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Invalid Date of Small Business Impact
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List the key subjects that are relevant to this regulation.
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Invalid Code of Massachusetts Regulation Index
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State the action taken by this regulation and its effect on existing provisions of the Code of Massachusetts
Regulations (CMR) to repeal, replace or amend.
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Invalid Promulgation
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