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INSTRUCTIONS FOR COMPLETING EPA FORM 7100-01

PAPERWORK REDUCTION ACT NOTICE

This form is to be used to request certification to purchase and apply Restricted Use Pesticides in Indian 

Country from the U.S. Environmental Protection Agency. 

1. Fill out all of the information. An email address is requested but is not required. Phone number listed 

should be one at which you can be reached during business hours. The address should be your business 

address, if applicable, for commercial applicators since this information will be posted to EPA's website.

2. Enter your birth date using the numerical month-month-date-date-year-year format. 

3. Enter your EPA Federal Applicator Identification number if this is a renewal or request for a 

replacement card. 

4. Certificate Type: Check appropriate box. If this is your first application for a pesticide applicator 

certification in Indian Country, check “Initial Certificate”. If contact information submitted on a previous 

form is erroneous or outdated, please use the “Replacement (Lost Card)” option.

5. Applicator Type: Check “Private Applicator” ONLY if you will be or are applying pesticides for 

production of an agricultural commodity on property owned or rented by you or your employer. All other 

applicators check “Commercial Applicator”. There is no “noncommercial” or “public” federal applicator 

type. 

6. Certification Method: In most cases you will check “Requesting federal certificate based on valid 

federal, state or tribal certificate or license”.

6a. Enter the two character state for which you hold a valid certificate/license, if applicable, the applicator 

number for your existing certificate, and expiration date. Enter the code for the category or categories for 

which you are currently certified/licensed. Attach a photocopy of both sides of your current and valid 

federal, state or tribal certification or license. The underlying certificate needs to come from a state or 

tribe that shares a contiguous boundary with the area of Indian country in which you intend to apply 

RUPs.

6b. If you do not hold a valid federal, state or tribal applicator certificate and you are applying to be a

private applicator, you may be certified after submitting documentation of completion of the on-line 

training course provided by EPA. However, in the interim while EPA is developing the course, private 

applicators can pursue this option by submitting documentation of completion of coursework or training 

that covers the general standards of competency outlined in 40 CFR 171.5 and 40 CFR 171.6. These 

standards include practical knowledge of pest problems and pest control practices associated with 

agricultural operations; proper storage, use, handling and disposal of the pesticides and containers; related 

legal responsibility; and practical knowledge of Federal supervisory requirements, including labeling, 

regarding the application of restricted use pesticides by noncertified applicators. Courses that cover the 

material outlined in 40 CFR 171.4(b) are also appropriate because they overlap with the material 

described in 40 CFR 171.5 and 40 CFR 171.6. For those taking the state training in the interim, EPA 

expects that this training will take an applicator at least 8 to 16 hours to adequately attain the knowledge 

necessary to apply restricted use pesticides. All courses used for this certification must be state-approved 

from states that have Administrator-approved certification plans, or otherwise approved by the 

Administrator. Training must be completed within the two years prior to certification. A false statement 
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in this certification, including regarding the completion of training, may be grounds for denial of 

certification and may be punishable by fine or imprisonment (U.S. Code, Title 18, Section 1001).

If you have questions about what courses are applicable, please contact the appropriate Regional

office (see addresses on page 3). To determine the appropriate Regional office, see 

http://www.epa.gov/epahome/whereyoulive.htm . Include documentation of completion of the 

required training course(s). 

To apply for recertification, complete one of the options described above during the 12 months preceding 

the expiration of your current certificate. 

7. Sign and date the application and mail the application with a photocopy of both sides of your existing 

federal, state, or tribal pesticide applicator certificate/license (if you are requesting certification based on a 

federal, state, or tribal certification) to the appropriate Regional office (see addresses on pages 2 and 3). 

To determine the appropriate Regional office, see http://www.epa.gov/epahome/whereyoulive.htm

Paperwork Reduction Act Notice: The public reporting burden for respondents completing this form is 

estimated to average about 10 minutes per response. Send comments (referencing OMB Control Number 

2070-0029 and EPA Form 7100-01) about the burden estimate or any other aspect of this collection of 

information, including suggestions for reducing the burden to: Director, Collection Strategies Division 

(2822T), U.S. Environmental Protection Agency, 1200 Pennsylvania Ave., N.W., Washington, D.C. 

20460. Do not send your completed application form to this address.

Privacy Act Statement: Title 7 United States Code, section 136i(a)(1) authorizes the collection of this 

information. The primary use of this information is to identify persons certified by EPA under the 

Agency’s federal certification plan which administers and oversees certification of applicators of 

restricted use pesticides. Disclosures of this information may be made pursuant to published routine uses, 

including to appropriate agencies for law enforcement purposes and to an EPA website for information 

purposes. Providing the requested information is voluntary, but failing to do so may result in EPA’s 

inability to approve your request to become, or maintain your status as, a certified applicator of restricted 

use pesticides. For a full description of this system notice, including routine uses, see EPA-59 [77 FR 

2060; January 12, 2012].
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Addresses for Submitting Form

Region Address

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Federal Plan Coordinator

Toxics and Pesticide Unit

Pesticides Program (OES05-4)

U.S. EPA - New England, Region 1

5 Post Office Sq, Suite 100

Boston, MA 02109-3912

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U.S. Environmental Protection Agency, Region 2

Pesticides Team

Attn: Pesticide Certification Training Coordinator

2890 Woodbridge Avenue

MS-500

Edison, New Jersey 08837

3 No Federally Recognized Tribes

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Federal Tribal Plan Coordinator 

USEPA Region 4 - Pesticides Section

61 Forsyth Street SW

SNAFC - 12th Floor

Atlanta, GA 30303

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U.S. EPA

Land and Chemicals Division, CMB

77 W. Jackson Blvd. LC-8J

Chicago, IL 60604

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U.S. Environmental Protection Agency

1445 Ross Avenue, Suite 1200

Pesticides Section (6PD-P)

Dallas, Texas 75202-2722

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Pesticide Applicator Certification Coordinator

U.S. Environmental Protection Agency - Region 7

WWPD/TOPE/PEST

901 N. 5th St

Kansas City, KS 66101

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US EPA, Region 8

Attn: Region 8 Certification

1595 Wynkoop St, 8P-P3T

Denver, CO 80202

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Federal Plan Coordinator

Pesticides Office (CED-5)

U.S. EPA Region IX

75 Hawthorne St.

San Francisco, CA 94105-3901

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Federal Pesticide Applicator Certification Program

Pesticides & Toxics Unit

US EPA, Region 10

1200 Sixth Ave, Ste. 900, OCE-084

Seattle, WA 98101