PFAS Supplier Declaration Template: What to Ask Each Supplier

A PFAS supplier declaration is a signed statement from a supplier saying, part by part, whether PFAS is intentionally added and, if so, which PFAS, how much, and why. If you report to Minnesota, the declaration has to carry the same fields as your PRISM report. A one-page “PFAS free” letter that names no parts will not fill them.

Download the template (CSV). It opens in Excel or Google Sheets. Fill in the part numbers before you send it, so the supplier only has to answer.

What fields does a PFAS supplier declaration need?

One row per supplier part, with these columns:

Field	Why you need it
Supplier part number and your part number	Ties the answer to a part on your bill of materials
Intentionally added PFAS: Yes, No, or Unknown	The core answer. “Unknown” is allowed but stays on your chase list
Component or homogeneous material	Minnesota reports at the component level, for example wire insulation, not the whole harness
PFAS chemical name	Required in the report
CAS number	Required in the report. Use another identifier only if no CAS number exists
Concentration range	Must fit Minnesota’s bands, listed below
Function	What the PFAS does in the part, for example lubricant, insulation, or coating
Basis for the answer	Shows whether the supplier knows, asked its own suppliers, or tested
Signer name, title, email, and date	Makes the declaration part of your due diligence record

These fields follow Minnesota Rule 7026.0030, which sets the report contents. New Mexico asks for similar data in its own system.

Which concentration ranges should suppliers use?

Ask suppliers to pick one of Minnesota’s ranges, so you can copy the answer straight into PRISM:

• Practical detection limit to less than 100 ppm
• 100 to less than 1,000 ppm
• 1,000 to less than 10,000 ppm
• 1% to less than 15%
• 15% to less than 30%
• 30% to less than 60%
• 60% to less than 90%
• 90% to 100%
• Present, but the amount is unknown

An exact amount is fine too. A vague answer such as “trace” or “below regulatory limits” is not.

What formats can suppliers send instead?

Accept any format that answers the same fields by part number:

• The template above, filled in and signed or sent from the supplier’s company email.
• IPC-1752A, the electronics industry material declaration. Check that it lists PFAS by CAS number and names the component.
• A signed letter that lists your part numbers and gives a Yes or No for each. It works only for parts with no PFAS.
• A full material disclosure of the part. You then find the PFAS yourself.

A website statement or a blanket “we comply with all PFAS laws” letter does not name parts, so it does not answer the question.

How do you check a declaration when it comes back?

Check every reply before you file it:

1. Part numbers match. Every part you asked about has an answer, and no answer is for a part you did not ask about.
2. CAS numbers are valid. A typo in a CAS number puts the wrong chemical in your public report.
3. Ranges fit the bands. Send back percentages that straddle two bands.
4. “No” is backed by something. A supplier that answers No for every part on the same day, with no basis, may not have asked its own suppliers.
5. The signer can speak for the parts. A sales rep’s “should be fine” is weaker than a quality or compliance contact’s signed answer.
6. The date is recent. A declaration from before a part change does not cover the new part.

Send back anything vague with a specific question. Then log the request, the reply, and the date. Minnesota requires you to keep asking until the data is known and to keep the records for five years.

How do you get suppliers to send it back?

Most suppliers have never been asked about PFAS. Public comments on Minnesota’s rule put response rates at about 30% to 40%, even after months of follow-up.

• Send it to the right person. A sales inbox rarely answers chemical questions. Find the quality or compliance contact.
• Pre-fill the parts. A supplier answers faster when it only has to fill in Yes or No.
• Give a date. Tie it to your own deadline, for example Minnesota’s February 1 update.
• Follow up on a schedule. Find a better contact when the first one goes quiet.

For the full Minnesota process, see Minnesota PFAS reporting: how to get the data from your suppliers.

TL;DR

Is there a standard PFAS supplier declaration form?

No single form is required. IPC-1752A is common in electronics. Any format works if it answers per part with the PFAS name, CAS number, concentration range, and function.

Is a “PFAS free” letter enough for Minnesota reporting?

Only if it lists your part numbers. A letter that names no parts does not support component-level reporting.

What if a supplier says the answer is unknown?

Record it, report “present but unknown” if needed, and keep asking. Minnesota expects you to update the report as data arrives.

Sources

1. Minn. Rules 7026.0030. Report contents and concentration ranges.
2. Minn. Rules 7026.0080. Supply chain requests and five-year records.
3. MPCA: Reporting PFAS in products. Deadlines and FAQ.
4. MPCA supplemental PRISM guide, March 2026. Component level reporting and unknowns.
5. MPCA response to comments, June 2025 and 2023 comment file. Supplier response rates.

Bridgecurrent sends this request from your own email, follows up until each supplier answers, checks every reply against these fields, and keeps the dated record. See pricing.