Jump to main content.


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

  1. 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.
  2. Submit the printed forms. The completed form(s) should be submitted in hardcopy in accordance with the existing policy.
  3. 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 ShaRon Carlisle, carlisle.sharon@epa.gov at (703) 308-6427
For biological/biochemical products, please contact Nicole Berckes, berckes.nicole@epa.gov at (703) 308-0152
For conventional pesticide products, please contact Sherada Hobgood, hobgood.sherada@epa.gov at (703) 308-8893

Mailed or Faxed Forms Only:
If you want these forms mailed or faxed to you, please contact Eleanor Thornton, thornton.eleanor@epa.gov

Document Processing Desk (distribution code)*
Office of Pesticide Programs (7504P)
U.S. Environmental Protection Agency
1200 Pennsylvania Ave. NW
Washington, D.C. 20460

Courier Address:
Office of Pesticide Programs
One Potomac Yard
2777 S. Crystal Drive
Arlington, VA 22202

* 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

 

 

 

 

 

 

 

If you have any problems accessing these forms, please contact Nicole Williams at (703) 308-5551 or by e-mail at mailto:williams.nicole@epamail.epa.gov?Subject=Problems with Registration Forms.

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
3540-16 Pesticide Report for Pesticide-Producing and Device-Producing Establishements
Instructions for Completing Application

Publications | Glossary | A-Z Index | Jobs


Local Navigation


Jump to main content.