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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.
- 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.
If you have any questions concerning how to complete these forms, please contact one of OPP's registration ombudspeople:
For antimicrobial products, please contact David Liem at (703) 305-1284
For biological/biochemical products, please contact Robert Torla at (703) 308-8098
For conventional pesticide products, please contact Sherada Hobgood at (703) 308-8893.Mailed or Faxed Forms Only:
If you want these forms mailed or faxed to you, please contact Michael Pearlman, pearlman.michael@epa.gov.
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Document
Processing Desk (distribution code)* Courier
Address: |
* 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 |
Pesticide Registration Forms
| 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 |
| 3540-16 | Pesticide Report for Pesticide-Producing and Device-Producing Establishements Instructions for Completing Application |