UNITED STATES ENVIRONMENTAL PROTECTION AGENCY

WASHINGTON, D.C. 20460

Endocrine Disruptor Screening Program (EDSP)

FFDCA §408(p) Order/FIFRA §(3)(c)(2)(B) Data Call-In (DCI)

Clear Form Data

OMB Control No.

2070-TBD

EDSP Tier 2 Testing, Initial Response Form for Individual Order Recipients

Paperwork Reduction Act Notice: The public reporting burden for this collection of information is estimated to average one hour per response. 

Send comments regarding the burden estimate to: Director, Collection Strategies Division (2822T), U.S. Environmental Protection Agency, 

Washington, DC 20460. Do not send the completed form to this address – follow the submission instructions in the order/DCI and Part 4 below.

Part 1 Recipient Information: (from the order/DCI and completed by the EPA)

A. Order/DCI #: B. Date Issued: C. Initial Response Due:

1.1. Order/DCI Info:

1.2. Company Name:

1.3. Address:

1.4. Contact Person:

A. Chemical #: B. Chemical Name: C. Company Number(s):

1.5. Chemical Info:

Part 2 Recipient’s Initial Response: (Please check the box next to your preferred response (2.1 – 2.7). Refer to the order/DCI for 

more information about response options, as well as detailed instructions on how to comply with the order/DCI.)

 2.1. I will generate new data or am citing/submitting existing data. For each required test () below, check the 

appropriate box (A, B, or C) and follow the order/DCI instructions to attach the data and/or required documentation.

A. I will generate new data.

B. I am citing/submitting existing data and/or other scientifically relevant information.

C. I am entering (or offering to enter) into an agreement to form a Consortium/Task Force to respond to the order/DCI. 

The Consortium/Task Force must provide a separate initial response within 150 calendar days from issuance of the 

order/DCI. (See EDSP Tier 2 Testing, Initial Response Form for Consortia/Task Forces at http://www.epa.gov/endo/.)

Required Test A B C Documentation is

Attached

 OCSPP Guideline 890.2100, Japanese Quail Two-Generation Toxicity    

 OCSPP Guideline 890.2200, Medaka Extended One-Generation Reproduction    

 OCSPP Guideline 890.2300, Larval Amphibian Growth and Development    

 OCSPP Guideline 870.3800, Reproduction and Fertility Effects*    

*[OECD TG 416 (Two-Generation Reproduction Toxicity Study) or 

OECD TG 443 (Extended One-Generation Reproductive Toxicity Study) are 

acceptable alternatives to OCSPP Guideline 870.3800]

 2.2 I am not subject to the order/DCI.

These Response Options Apply Only to Registered Pesticides:

 2.3 I intend to voluntarily cancel the pesticide registration(s). 

 2.4 I intend to reformulate the product(s) to exclude this chemical from the formulation. 

 2.5 I am claiming a formulator's exemption. 

These Response Options Apply Only to Pesticide Inert Ingredients (aka, Inerts):

 2.6 I have/am in the process of discontinuing the manufacture/import of this chemical. 

 2.7 I do not and will not sell my chemical for use as an inert ingredient to the pesticide market. 

Part 3 3.1. Certification: 

I certify that the statements made on this form and all attachments are true, accurate and complete. I acknowledge that 

any knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.

3.2 Company's Authorized Representative 3.3 Date

Signature:

Name & Title: 3.4 Telephone Number

Email Address:

Part 4 Detailed submission instructions can be found on the EPA's EDSP Internet homepage at http://www.epa.gov/endo.

EPA Form No. 6300-07 (Draft, June 2015)