INS TRUCTI ONS
Refer to 40 CFR 172 for regulations regar ding expe rimenta l use perm its. The se regulations we re published i n the FEDERA L REGI STE R on April 30, 1975 ( 40 FR 18780). Com plete all (and only) numbere d items on the applic ations for m. If an EPA Com pany Num ber (It em 2) has not previously been assigned, indicate “None,” and a number will be assigned on your acknowledgment copy of the form

. Third party applicants (those who will be testi ng another f irm’s r egister ed product) ne ed not com plete Ite m 13. On the acknow ledgme nt copy of this form , you w ill be ass igned a File Num ber or Sy mbol for identific ation of thi s applicat ion. An ex pected com pletion date and the nam e of y our EPA Contac t wil l be entered. You may call y our EPA Contac t if y ou have not r eceive d your per mit or a letter of explanat ion by the date indica t ed. Experi mentalUse Permi t Data Submi ssi on
The following inf ormation m ust be subm itted in triplicate and in detail (bound in remov able sec tions A thr ough G w ith marg in tabs) f or all new chemicals and m any new products. For some new f ormulations, the information requested in Items C, D, E, and F may be inclu ded by ref erence to other for mulations if adequa te extra polation ma y be m ade. Whe re the applicant reque sts perm ission to tes t a regi stered produc t, the infor mation requested i n Items B, E, F, and G below, a long with the EPA Reg istration N umber of the product, w ill usually suffi ce. Ref er to 40 CFR 158.640 [53 FR 15993, May 4, 1988] for fur ther infor mation. A. A data sheet giv ing the chemical and physical properties of the chemic al. A complete statem ent of the names and percentage s by weight of each Active and Inert Ing redient in the formulation to be shi pped. This i nforma tion will be handled as confidentia l mate rial. B

. One copy of the propos ed label including direc tions for us e necess ary f or evalua tion of the pr oduct. Ref er to 40 CFR 172.6 f or mi nimum labeling r equirem ents. In ce rtain circ umstanc es the ex perime ntal progra m or other suppleme ntal labeli ng may be perm issible in l ieu of f ull labeling. In such cas es, subm it a full explanat ion as to how the labeli ng will be aff ixed to or a c compa ny the c ontainer. C. Toxicity data or refere nce to available data on the toxicity of the pesticide including, where pertinent, date on the toxicity to fish and wildlife. Includ e a summary of this infor mation. LD 50 values a nd results of eye i rritation st udies on the f ormulated product mus t be included. D. Residue data, where pertinent, on (a) food or feed commodities; (b) nonfood crops such as tobacco; and (c) foliage or other s ites which may relate to worker hazard or adverse ef fects on the environment. Include a description of the analytical method(s) used in a sum m ary of the data. E. Effec tiveness data [required only if specif ied in Reg ulations 40 CFR 158.640, 53 FR 15993. May 4, 1988 and Reg istration G uide lines 40 C F R 158. 202( i), 53 FR 1599 3, Ma y 4 , 198 8]. F. If the pe sticide is to be tested in a ma nner involv ing food or f eed, and an adequate tolerance i s not establ ished to cov er th e use , file a petition f o r a tempor ary tol erance w ith this A gency and forw ard three copies w ith this applic ation. If appropriate tolerance s are es tablish ed a lready , cite applicable Regulation in Title 40 of the Code of Federal Regulations. G

. Pro pose d Exp erimen tal P rogra m: (1) Giv e the qualif ications a nd the nam e s, addres ses, and telephone numbe rs of the individuals (participa nts) who w ill superv is e the experimental work. (2) Name the St ates in which the pestic ide will be u sed and th e acreage to be t reated in each State. Where “acreage” do es not app ly, give extent of testing pe r State in m ore appropria te term inology. Indicate s eparatel y any other State (s) to which the pest icide m a y be s hipped for further di stribution. (3) Give the details of the proposed program including the types of target pests a nd organisms, the crops, animals, surfaces, m aterials, buildings, or sites of application to be treated and the major geographical areas where the material is to be used. For seasona l pests or crops, indicate the desired m onth for pes ticide application to beg in. Specif y the us e pattern, intended plot s i zes, num ber of plots , number of replicates, dosage rates, methods of application, season of use (spring, summe r, fall) and timing of application (preplant, pos temergence, multiple (indicate pattern and num ber), etc .). (4) List the objectives of the proposed program including, e.g., what types of data w ill be collected during the testing period (performance, yield, phytotoxicity. environmental residue, etc.). Indicate your long-range testing plans, including how many years y ou expec t to conduct exper imenta l test ing in supp ort o f regist ratio n of th is use

. This infor mation will b e help ful in evalu atin g the cu rren tly pro p ose d pro gram. (5) Submit an explana tion to justif y the qua ntity of the ma terial requested, inc luding var ious param eters used to determ ine the quanti ty. Quantities authorized w ill be based on the progra m subm itted and cons ideration of the type s and am ount of data required to s upp ort registra tion. (6) Propose a s uitable dura tion for the permit comm ensurate w ith the progr am. A ny reque st for a period gre ater than 1 year mustbe adequately justified. (7) S tate t he meth od o f disp osit ion o f any un used materia ls left at the concl usio n of th e test ing p rogra m.
Paperw ork Reduction Act Notice The public reporting burden for this collection of information is estimated to average 0.75 hours including time for reviewing instructions, gathering existing product source s and addres ses, shippe rs to be use d and address es, and com pleting this instrume nt. Send com m ents r e garding this estima te or any other aspe ct of this process, including sug gestions f or reducing burden to : Dir ector, Collection Strategies Di v ision, 1200 Pennsylva nia Ave nue, N.W., Washingt on, DC 20460; Of fice of Managem e nt and Budge t. Paperwor k Reduction Act Projec t(2070-0040), Washingt on, DC 20503, m a rked “A ttention: De sk Off icer for EPA.”
NOTE : App lic ant may ret ain last cop y ( 11-24-2003)