Supplier PFAS declaration: a free template
A request email and a one-page declaration you can send to each supplier today. Copy them, fill in the brackets, and keep every reply.
Why you need one per material
Minnesota, Washington, New Mexico and Connecticut all ask about PFAS that were intentionally added to a product or one of its components. Your suppliers are the people who know. A signed answer for each material is what fills in a state report, and it’s the record that shows you asked.
Minnesota’s rule, for one, expects you to keep requesting supplier information until the missing data is known, to document every communication, and to keep those records for five years after a product leaves the supply chain (Minn. R. 7026.0080).
The request email
Send one email per supplier and material. Name the exact fabric, coating or part code.
Subject: PFAS declaration needed for [material code or PO number] (reply by [date])
Hello [name],
[Your company] has to report PFAS (per- and polyfluoroalkyl substances) in products sold in several US states, including Minnesota, Washington, New Mexico and Connecticut.
For [material description] ([material code]), please tell us:
1. Is any PFAS intentionally added? For example a fluorinated water- or stain-repellent finish (including C6), PTFE or another fluoropolymer, or a fluorinated wax or lubricant.
2. If yes, the chemical name and CAS number, or “proprietary.”
3. What it does in the material.
4. The concentration, or a range from the attached form.If no PFAS is intentionally added, signing part A of the attached declaration is enough.
Please reply by [date, 14 days from today]. If someone else on your team handles chemical compliance, please forward this to them.
Thank you,
[Your name], [title], [company]
cc: [your buyer]
The declaration form
Attach this to every request. Paste it into a document with your logo, or send it as is.
| Supplier company | ____________________ |
|---|---|
| Address | ____________________ |
| Contact name and email | ____________________ |
| Material or part description | ____________________ |
| Material or part number | ____________________ |
| Customer and PO or reference | ____________________ |
Part A: no intentionally added PFAS
☐ We declare that, to the best of our knowledge, no PFAS (per- and polyfluoroalkyl substances) are intentionally added to the material above as supplied to [customer company]. This includes fluorinated water- and stain-repellent finishes, PTFE and other fluoropolymers, and fluorinated waxes and lubricants.
Part B: PFAS intentionally added
☐ PFAS are intentionally added. Details for each one:
| Chemical name | CAS number | Component or layer | Function | Concentration band |
|---|---|---|---|---|
| ________ | ________ | ________ | ________ | ________ |
| ________ | ________ | ________ | ________ | ________ |
| ________ | ________ | ________ | ________ | ________ |
Concentration bands: under 100 ppm; 100 to under 500; 500 to under 1,000; 1,000 to under 5,000; 5,000 to under 10,000; 10,000 ppm or more (give the exact value if known); unknown.
Function, for example: water repellency, stain resistance, nonstick, lubrication, other.
Attached (optional): ☐ safety data sheet ☐ test report ☐ other: ________
Signature
I confirm this is accurate to the best of my knowledge.
| Name | ____________________ |
|---|---|
| Title | ____________________ |
| Signature | ____________________ |
| Date | ____________________ |
Why the form asks what it asks
- “Intentionally added” is the test all four filing states use: PFAS deliberately added because it does something in the product (Minn. Stat. 116.943, subd. 1).
- Fluoropolymers are named because Minnesota and Connecticut have no fluoropolymer exemption. New Mexico exempts solid fluoropolymers, but you still need to know they’re there. See why “PFC-free” isn’t enough.
- The concentration bands are Washington’s reporting ranges, and New Mexico uses the same ones (WAC 173-337-060). They fit inside Minnesota’s wider ranges, except above 10,000 ppm, where Minnesota splits further. That’s why the form asks for the exact value there.
- The component matters because Minnesota and Washington report PFAS by the part that contains it, such as a face fabric, membrane or zipper coating.
Getting answers
- One request per supplier and material. A supplier making three fabrics for you gets three requests, each with its own code.
- Offer the easy answer first. If nothing is added, part A and a signature is the whole job.
- Write in their language. If the factory works in Chinese or Vietnamese, send the email and the form in that language too.
- Send from your own domain, or copy your buyer. Suppliers answer customers.
- Give a deadline. Fourteen days is enough for most.
A follow-up schedule
- Day 0: send the request and the form.
- Day 7: a short reminder, asking them to forward it if someone else handles compliance.
- Day 14: a final request. Say that without an answer, the material will be reported as “PFAS status unknown,” and that you’ve recorded the request.
- Day 21: your buyer follows up directly, by phone or email.
- Day 28: file what you know, mark the rest as an open item, and keep asking for your next update.
Log every send, reminder, reply and silence with its date. The log is the evidence. Minnesota’s PRISM accepts “unknown” for a chemical, function or range when a supplier hasn’t answered (MPCA PRISM guide).
A template, not legal advice
Adapt the wording to your products and suppliers. Whether a product is in scope, and what a given state accepts as evidence, depends on the rule text for that state. The scope checker is a quick first pass, and your counsel can review the template before you use it.
Rather not chase suppliers yourself? We send the requests, follow up and keep the log.
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