United States

Environmental Protection Agency Office of Prevention Pesticides, and

Toxic Substances EPA 747

- B

- 99

- 001

March 20 10 https://www.epa.gov/lead 

# Application and

Instructions for Firms

Applying for Certification to Conduct Lead

- Based

Paint Ac tivities and Renovations

# [This page intentionally left blank]Form Approved OMB No. 2070

- 0155 Expires 10/31/11

EPA Form 8500

- 27 (Rev 3/ 10 ) Page 1 of 2 

### A PPLICATION FOR 

### F IRMS

U.S. E NVIRONMENTAL P ROTECTION A GENCY T O C ONDUCT L EAD -B ASED P AINT A CTIVITIES / OR R ENOVATIONS

Important: This application is required by 40 CFR §745.89(a) for renovat ions and is a substitute for the letter required by §745.226(f)(2) for abatement . Consult the instructions for f i rms applying for certification to conduct lead

- based activities or renovations. For abatement activities, p ersons seeking individual certificat ion should use the Application for Individuals instead of this form

. Please fill out all sections. Type or print responses in black or blue ink only.

A. General Information Select one of the following application types for lead

- based paint activities : (abatement, inspection, risk assessment) and/ or Repair, Renovation, and Painting (RRP) (renovation or dust sampling technician)

Initial certification application
– renovation (RRP)

Initial certification application
- abatement, inspection, risk assessment

Re

- certification application
– renovation (RRP)

Re

- certification application
- abatement, inspection, risk assessment

Combined certification
- abatement, inspection, risk assessment and renovation

Combined re

- certification
- abatement, inspection, risk asses sment and renovation

Adding jurisdiction[s] * to certification/amending certification

Replacement of a certificate

* The fee you must pay for the above certifications depends on the number of EPA

- run jurisdiction[s] in which you plan to conduct lead

based paint activities ( jurisdictions do not apply to renovation certification)

. See the fees schedule in the instructions to determine your

fee. The total fee listed below should include fees calculated on any additional sheets.

1 st EPA

- run jurisdiction (pay b ase certification fee only)

............................................................................. Fee: $
(See the definition of EPA

- run jurisdiction[s], the fee example and an explanation of the combined application

in the instructions. For current listing of EPA

- run jurisdictions, see www.epa.gov/lead or call 1

- 800

- 424

- LEAD).

Each additional EPA

- run jurisdiction:

........................................................................................................... Fee: $
(List on additional sheets of paper and attach, as necessary. $35 per jurisdiction)

Certification for Renovations only (jurisdictions do not apply to renovation c ertification ) :

...................................... Fee: $

__________________________ Total Fee $

B. Applicant Information

Check here if you are a federally

- recognized Indian tribe seeking certification as a firm.

Name of Firm:

Business Address: Street Address, Suite Number (Please no P.O. Box) City State Zip C ode

Mailing Address: (if different from above) Street Address, Suite Number (Please no P.O. Box) City State Zip Code

Name of Attesting Individual:

Last First Middle

Firm’s Phone #: ext #: Attesting Individual’s Phone #: ext.

Attesting Individual ’s E

- mail Address:

C. Professional Certifications

Does the firm hold current permits, licenses, certifications, or registrations in the lead

- based Yes No paint field in any state, U.S. territory, or Indian tribal land?

If yes , please fill in the following blanks, one line for each permit, license, certification, or registration held. Attach additional sheets of

paper, as necessary.

Type of certification held State, U.S. Territory, or Indian tribal land(s) name Certification/Identification Number Date received

Type of certification held State, U.S. Territory, or Indian tribal land(s) name Certification/Identification Number Date received For information on EPA and other Lead Programs, see: http://www.epa.gov/lead

. C heck below for how your firm should be listed on EPA’s

web site:

for Evaluation

for Lead Abatement

for Renovation Official Use OnlyForm Approved OMB No. 2070

- 0155 Expires 10/31/11

EPA Form 8500

- 27 (Rev 3/ 10 ) Page 2 of 2 D. Lead

- Based Paint Activity or Renovation Violation [s]

Does the firm have any past, present, or pending lead

- base d paint violations of EPA, Yes No State, U.S. territory, or Indian tribal land(s) regulations? If yes , please attach a written explanation.

E. Certification Statement

Fill in the blanks in the following statement as indicated.

attests that

Name of At testing Individual Name of Firm

shall only employ appropriately qualified individuals to conduct lead

- based paint activities and renovations

.

( Name of Firm ) and its employees shall follow the work practice

standards set forth in 40 CFR § 745.227 for conducting lead

- based paint activities or 40 CFR § 745.85 for conducting renovations at all

times.

I hereby attest and affirm that the information included on this application, including any attachments, is true and accurate to the be st of my belief and knowledge. I acknowledge that any certification issued pursuant to this application, including any attachments, will be subject to revocation if issuance was based on incorrect or inadequate information that materially affected the decision to issue the

ce rtification.

Attesting Individual’s Signature Date Signed

(Please sign legibly within the boundaries of the box above.)

________________________________________________________________ _ Attesting Individual’s Title (please print)

Before you mail your application and certification fee, make sure that you have:

Filled out all applicable sections of the application

Signed and dated the application

Made a copy of your application for your files

Enclosed the appropriate certification fees (check or money order)

Printed “ Lead Program User Fees” on the check or money order

For more information, see the fees section of the instructions

Mail original completed application, supporting materials, and the certification fee to:

U.S. EPA

Lead User Fees

P.O. Box 979072 St. Louis, MO 63197

- 9000 Privacy Act Statement: This statement is provided pursuant to the Privacy Act of 1974, 5 U.S.C. §552a. The authority for collecting this information is 40 C.F.R. Part 745, and 15 U.S.C. §§2682 and 2684. The information collected on this form will be used to establish the applicant’s eligibility for certification to conduct lead

- based paint activities and renovations in t arget housing and child

- occupied facilities. Disclosure of this information is voluntary; however, the failure to provide this information may delay or prevent an applicant’s certification. This information may be disclosed in appropriate and limited circumstances to: EPA employees, contractors, grantees or others when performing duties that are compatible with the purpose for which this information is collected and when this information is necessary to complete the task; a member of Congress in response to a request made with your consent and on your behalf; to appropriate law enforcement agencies responsible for investigating, enforcing, prosecuting or implementing specific statutes, codes or regulations and this information is relevan t to that responsibil ity; an appropriate adjudicative body when such disclosure is compatible with the purpose for which this information is collected and the EPA or the United States has an interest in the proceeding; and the Department of the Treasury, the General Services Administration, the General Accounting Office and other Federal, State, and Local Agencies for

authorized activities related to this information.INSTRUCTIONS FOR FIRMS APPLYING FOR CERTIFICATION TO CONDUCT LEAD

- BASED

PAINT ACTIVITIES AND RENOVATIONS

Firms must apply to the U.S. Environmental Protection Agency (EPA) to be certified or recertified to perform or offer to perform renovations or lead -b ased paint activities (abatement, inspection, or risk assessment) in states, U.S. territories, and all Indian tribal land(s) in any one EPA Region where EPA implements the lead

- based paint certification program. If EPA does not administer the certification program in an area where a firm wishes to work, the firm must apply directly to that state, territory, or

Indian tribe for certification. EPA has up to 90 days after receiving a complete request for certification to approve or disapprove the application.

Firms must become certified under the Renovation, Repair and Painting Rule to conduct renovations and post

- renovation dust sampling. Firms must become certified for lead

- based paint activities to conduct abatements, inspections and risk assessments.

Th ese instructions supplement OMB approved form No. 2070

- 0155

, Application and Instructions for

Firms

. Please note that you must use a separate form for each application type (i.e., initial certification , re

certification , amending certification

, adding juri sdictions, or replacement of a certificate).

How to Apply for Initial Certification

Firms submit their application and payment by mail by doing the following :



### • Complete, sign, and date EPA form 8500

- 27 (Rev 0 8/09 ). The form can be filled out by hand or by using a fillable form on your computer ( http://www.epa.gov/lead/pubs/firmapp.pdf ).



### • Calculate the appropriate fee using the fees schedule provided in the se instructions

.



### • Print “Lead Program User Fees” on the check or money order for the fee and mail it with your application to the following address:

U.S. EPA

Lead User Fees
P.O. Box 979072 St. Louis, MO 63197

- 9000

How to Apply for Re

- certification

Firms must be re

- certified every five (5) years for renovations and three (3) years for lead

- based paint

activities (abatement, inspection, risk assessment). To ensure that your firm will be re

- certified before its current certification expires, you should submit a re

- certification application well before the expiration date.

For re

- certification, complete all sections of the application and follow the mailing instructions described in

the “Initial Certification” section of these instructions.

Combined Applications

F irms can apply for certification under the Renovation, Repair, and Painting Rule and Lead

- ba s ed Paint Activities Regulations (abatement, inspection, risk assessment) on a single application for a single fee of $550

. For Tribal government entities, the fee is $20. Firms that apply on separate applications will have to pay the appropriate fee for e ach. The lower fee would only apply when a single firm applies for both certifications on the same firm application in a State or Tribe where EPA implements both programs.

Note: EPA implements the Lead

- based Paint Activities Regulation s (abatement, inspe ction, risk assessment) in only 11 states . Do not select a combined application if EPA does not administer the Lead

based Paint Activities (abatement, inspection and risk assessment) program in the jurisdiction in which you work. To find out which states EPA administers the Lead

- based Paint Activities (abatement, inspection, risk assessment) visit EPA’s web page at http://www.epa.gov/lead/pubs/traincert.htm#whereAmended Application

A ny change to the information reported to EPA in a firm's most recent certification application must be reported in an amended certification application. There is no cost associated with the submission of an

amended certification.

Amended applications must be sent to the following address:

U.S. EPA

P.O. Box 14417 Washingto n, DC 20044

- 4417

R eplacement of a Certificate

To replace a certificate, complete only sections A (General Information), B (Applicant Information), and E (Certification Statement) of the application and follow the mailing instructions described in the “In itial

Certification” section of these instructions.

Incomplete Application

If any components of your application are missing, your application will become inactive for a period not to exceed 30 days until the application is made complete. If you do not complete your application, EPA will return the application package. You may apply again with a complete package. Please call 1

- 800

- 424

- LEAD to find out if your application is complete.

Firms Completing Applications for Individuals Under Lead

- based Paint Ac tivities (Abatement, Inspection, Risk Assessment)

If the firm is assisting in completing applications for individuals who are applying for certification under

lead

- based paint activities, please be aware of the following:



### • Individual s must have an address and phone number different from the firm’s.



### • Individual s must sign and date the application.



### • Individual’s name, and discipline should appear on the front of the application fee payment (check or money order), even if it is hand

- written, if the firm pays for the individual.



### • EPA forwards all correspondence to individuals who have signed the application attesting to their willingness to comply with the work practice standards found at 40 CFR §745.227 and/or at

40 CFR §745 .85

.



### • EPA forwards copies of the individual’s approval letter and certificate to the firm upon written request of the applicant; however, the approval letter, identification badge, and certificate remain the property of the individual.

Fees

The fee for applying for certification, re

- cert ification, and other requests is listed in the following sche dule. It is important that you:



### • Calculate fee based on the number of EPA

- run jurisdiction(s) in which you plan to operate. a) If applying for lead RRP certification , there is NO jurisdictional fee
– the certification or re certification fee is a n ational certification for all jurisdictions where EPA administers the

program.

b) If applying for lead

- based paint activities certification (abatement, inspection, risk assessment) , submit a $35 dollar fee e ach additional EPA

- run state or territory, or all Indiantribal land[s] located in each EPA Region, (e.g., if applying for certification in multiple Indian Tribal lands located in Region 5 and Region 7 you must pay a $35 fee per Region, or a total of $70).



### • Write your total fee amount in section A of the application, even if you attach additional sheets of paper listing additional EPA

- run jurisdictions.



### • Make the check or money order payable to U.S. Environmental Protection Agency. Other methods of payment include wire transfer, electronic funds transfer, and, for government payers only, on

- line payment agency collection (OPAC).

Fees Schedule

Description Fee

Replacement Certificate $15

Renovation Firm Certification Certification Recertification

Firm $300 $300

Tribal Firm $20 $20

Combined Renovation and Lead

- based Paint Activities Firm Application $550 $550

Combined Renovation and Lead

- based Paint

Activities Tribal Firm Application $20 $20

Lead

- based Paint Activities Certification (Abatement, Insp ection, Risk Assessment) Certification Recertification

Firm $55 0 $550

Tribal Firm $20 $20

Combined Renovation and Lead

- based Paint Activities Firm Application $55 0 $55 0

Combined Renovation and Lead

- based Paint

Activities Tribal Firm Application $20 $20

Multi

- jurisdictional Certification Fee* $35 for each additional EPA

- run jurisdiction**

*Multi

- jurisdictional certification applies to lead

- based paint activities (abatement, inspection, risk assessment) for an applicant applying in more than one EPA

- run jurisdiction. This fee does not apply to

renovation firm certification.

**An EPA

- run jurisdiction includes an EPA

- run state, a U.S. territory, or all Indian tribal land(s) in any one

EPA Region. (For current listing of EPA

- run jurisdictions, see www.epa.gov/lead or call 1

- 800

- 424

- LEAD.)

Fee Example

If your firm is applying for initial certification for lead

- based paint activities (abatement, inspection, risk assessment) in two states and all Indian tribal land(s) in any one EPA Region, you r firm is r equired to pay $620:

Initial l ead

- base p aint a ctivities (abatement, inspection, risk assessment)

firm certification fee $550

One additional state fee* $ 35

All India n tribes in one EPA Region fee* $ 35

Total Amount Due: $620If your firm is applying for initial certification to conduct renovation s and intends to work in multiple states,

you r firm is required to pay $300:

Initial renovation firm certification fee $ 30 0

A dditional jurisdiction fee does not apply to renovation certification $ 0

Tota l Amount Due: $ 30 0

If your firm is submitting a combined application for initial certification in lead

- based paint activities (abatement, inspection, risk assessment) and renovation, you r firm is required to pay $550:

Initial combined certification fee f or lead

- based paint activities (abatement, inspection, risk assessment)

and renovation $550

Total Amount Due: $ 55 0

*Each certification request for lead

- based paint activities (abatement, inspection, risk assessment)

includes the fee for one EPA

- run juri sdiction. The multi

- jurisdiction fee does not apply to renovation

certification.

EPA’s Certification Fees Refund Policy

Firms having submitted an application and associated fees for certification or re

- certification who wish to withdraw their application prior to Agency approval will receive a fee refund based upon the schedule

listed below. Firms who request a refund more than 10 days after the Agency receives the application will not receive a 100 percent refund.

Number of Days Following Agency Receipt of Application Percent Reimbursable (based upon total fees submitted)

up to 10 days 100%

11 to 60 days 75%

61 to 120 days 50%

121 or more days 25%

Note: Refunds will only be made after EPA verifies fee receipt and deposit by the U.S. Treasur y.

Firms must notify the Agency in writing in order to qualify for a refund. The date of withdrawal is the date on which the Agency received the withdrawal notification.

EPA will not refund fees after granting a firm certification or re

- certification. If your application is disapproved, EPA will not refund fees.

Refunds are not available for replacing a certificate.

Refund and withdrawal requests must be sent to the following address:

U.S. EPA

P.O. Box 14417 Washington, DC 20044

- 4417Application Process for Firm Certification EPA processes applications on a first

- come, first

- served basis. The following flowchart depicts the application process for firm certification. EPA has up to 90 days after receiving a complete request for certification to approve or disapprove the application.



### Firm submits application and fee to EPA

Is the application complete?

EPA sends the firm a letter indicating that the application is complete

Is the applicant qualified?

EPA sends approval

letter and certificate EPA returns application with an explanation of deficiency EPA sends letter detailing missing information Firm submits missing information

Yes

Yes No

No

Paperwork Reduction Act Notice: The annual public burden for this collection of information is estimated to be 7.5 hours for firms, including the time needed for reading the instructions and completing the necessary information contained in this form. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to: Director, Collection Strategies Division, Office of Environmental Information (OEI), U.S. Environmental Protection Agency (Mail Code 2822), 1200 Pennsylvania Avenue, N.W., Washington, D.C. 20460. Include OMB number 2070

- 0155 in any correspondence. Do not send the completed form or requested information to this address. The actual information or form should be submitted in accordance with the instructions accompanying the form, or as specified in the corresponding regulations.