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HPV Challenge Program Response

Title of Submission/Category and/or Chemical Name:

Date of Submission:

Company / Consortium Name:

Technical Contact Person Name:

Technical Contact Person Email Address:

Format of most recent HPV submission (please check the appropriate box):
Word Processing Software (eg., Microsoft Word, Corel WordPerfect)
IUCLID 4.02 Export File   (    IUCLID 4.02 Category Merge Function Used)
IUCLID 4.02 format, data exported into Word Processing Software and edited prior to submission

Selection for entering the HPV data into the HPVIS:
My organization will enter our previously submitted data directly into HPVIS
My organization will submit an International Uniform Chemical Information Database (IUCLID) 4.02
          export file to EPA and will validate the submission once EPA completes the upload to the HPVIS
My organization will validate our previously submitted data that are entered by EPA into the HPVIS


Paperwork Reduction Act Notice: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number covering the information collection activities for the voluntary HPV Challenge Program is 2070-0033. The annual public burden for completing this response is estimated to be no more than 30 minutes per response, including the time needed for reading the instructions and completing the necessary information contained in this form. Send any comments regarding this burden estimate to: Director, Collection Strategies Division, Office of Environmental Information, U.S. Environmental Protection Agency (Mail Code 2822T), 1200 Pennsylvania Avenue, N.W., Washington, D.C. 20460. Include the OMB control number identified above in any correspondence. Do not send the completed form to this address. The form should be submitted in accordance with the instructions accompanying the form.

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