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Pesticide Registration Forms
The
following forms are provided as an aid for registering
a pesticide product. For guidance in selecting the appropiate form consult
the Pesticide Registration
Kit or contact one of OPP's registration ombudspeople listed below.
Instructions
- Complete the
forms. The forms below were created as "fill-in and print" PDF files.
The Acrobat reader
is required to view or access these forms. You may download the
forms to your PC, complete them on-line or print the blank form
to complete it.
- Submit the
printed forms. The completed form(s) should be submitted in hardcopy
in accordance with the existing policy.
- Mail the forms
to the address below for the Document Processing Desk. Include any
additional documents necessary to comply with EPA regulations covering
your request, DO NOT fax or e-mail any form containing 'Confidential
Business Information' or 'Sensitive Information.
Mailed or Faxed Forms:
If you want these forms mailed or faxed to you, please contact
Lois White, white.lois@epa.gov
or Floyd Gayles, gayles.floyd@epa.gov
at (703) 305-6549.
If you have
any questions concerning how to complete these forms, please
contact one of OPP's registration ombudspeople:
For
antimicrobial products, please contact Michael Hardy at (703) 308-6432
For biological/biochemical products, please contact Robert Torla at
(703) 308-8098
For conventional pesticide products, please contact Linda Arrington
at (703) 305-5446.
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Document Processing
Desk (distribution code)*
Office of Pesticide Programs (7504C)
U.S. Environmental Protection Agency
1200 Pennsylvania Ave. NW
Washington, D.C. 20460
Courier Address:
Office of Pesticide Programs
Crystal Mall #2
1801 Bell Street
Arlington, VA 22202
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Note Distribution Codes are as follows:
(APPL) Application for product registration
(AMEND) Amendment to existing registration
(CAN) Voluntary Cancellation
(EUP) Experimental Use Permit
(DIST) Supplemental Distributor Registration
(SLN) Special Local Need
(NEWCO) Request for new company number
(NOTIF) Notification
(PETN) Petition for Tolerance
(XFER) Product Transfer
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If you have any problems accessing these forms, please
contact Nicole Williams at (703) 308-5551 or by e-mail at williams.nicole@epa.gov.
Security
and Privacy Notice 
| 8570-1 |
Application
for Pesticide Registration/Amendment (172 KB) |
| 8570-4 |
Confidential
Statement of Formula (178 KB) |
| 8570-5 |
Notice
of Supplemental Distribution of a Registered Pesticide Product (99
KB) |
| 8570-17 |
Application
for an Experimental Use Permit (242 KB) |
| 8570-25 |
Application
for/Notification of State Registration of a Pesticide To Meet a Special
Local Need (137 KB) |
| 8570-27 |
Formulator's
Exemption Statement (129 KB) |
| 8570-28 |
Certification
of Compliance with Data Gap Procedures (75 KB) |
| 8570-32 |
Certification
of Attempt to Enter into an Agreement with other Registrants for Development
of Data (101 KB) |
| 8570-34 |
Certification
with Respect to Citations of Data (20 KB) (as referenced in
PR Notice
98-5) |
| 8570-35 |
Data
Matrix (68 KB) (as referenced in PR
Notice 98-5) |
| 8570-36 |
Summary
of the Physical/Chemical Properties (623 KB) (as referenced
in PR
Notice 98-1) |
| 8570-37 |
Self-Certification
Statement for the Physical/Chemical Properties (275 KB) (as
referenced in PR Notice 98-1) |
| 3540-8 |
Application
for Registration of Pesticide-Producing and Device-Producing Establishment
Instructions
for Completing Application |
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