California Form Dpr 035 PDF Details

Navigating the intricacies of pesticide product amendments in California requires a solid understanding of the California DPR 035 form, a crucial document for those in the agricultural and pest control industries. Designed to streamline the process of making modifications to pesticide products, this form serves as a comprehensive application for businesses aiming to update their products' usage, labeling, or other key attributes. Applicants must meticulously provide firm and product information, including the firm's name and address, the product brand name as registered, and the specific amendment action they are requesting. From adding new crops and sites for use to modifying precautionary statements or adjusting the product's indoor use parameters, each amendment type necessitates supporting scientific data, underscoring the form's role in ensuring the safety and efficacy of pesticide use in the state. Beyond the form itself, applicants are guided through a structured process of submission, which includes attaching a detailed cover letter, paying the specified fee, and understanding the obligations related to data sharing and copyright, highlighting the form's importance in regulatory compliance and the protection of public health and the environment. Additionally, the California Department of Pesticide Regulation provides extensive resources and instructions for applicants, emphasizing the thoroughness required in the submission process and the accessible support available to navigate these regulatory pathways. This process not only facilitates product improvements and innovations but also aligns with California's rigorous standards for environmental safety and consumer protection.

QuestionAnswer
Form NameCalifornia Form Dpr 035
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesamend_form california dpr 035 form

Form Preview Example

APPLICATION TO

AMEND PESTICIDE PRODUCT

DPR-035 (05/06)

Page 1 of 2

DPR USE ONLY:

Tr. ID#________________________________

Reg. No._______________________________

R.S. Assigned __________________________

Applicant Information

 

Important: Read all instructions before completing this form.

1.

Firm Name

 

 

 

 

 

 

 

 

 

 

 

2.

Mailing Address of Firm

Check box if updated address

City

State

Zip Code

 

 

 

 

 

3.

Street Address (if different from above) or Agent Address

City

State

Zip Code

 

 

 

 

 

 

4.

Name of Authorized Representative

 

 

 

 

 

 

 

 

 

 

5.

Telephone Number of Representative

6. Fax Number

 

7. E-mail Address

 

 

( )

 

( )

 

 

 

 

 

 

 

 

 

 

Product Information

8.Product Brand Name (exactly as shown on label)

9.U.S. EPA Registration Number (or California Registration Number for Spray Adjuvants)

10.Type of California amendment action requested that must be supported by scientific data.

Addition of a crop. Addition of sites or uses. Addition of indoor use.

Adding the first agricultural use for the active ingredient. Adding pests or types of pests not already on the label. Reducing the signal word or the precautionary statements. Other (explain in cover letter).

NOTE: Minor amendments not requiring scientific data are not subject to the fee and do not require an application form.

I certify, under penalty of perjury, that all information submitted on this application to amend pesticide product is accurate and complete.

X_____________________________________ / _____________________________________________/ ____________________

Signature of Authorized Representative

Type or Print Name/Title

Date Signed

Mail completed application to:

For correspondence only: Department of Pesticide Regulation Pesticide Registration Branch P.O. Box 4015

Sacramento, California 95812-4015

For package deliveries, Fed Ex, etc: Department of Pesticide Regulation Pesticide Registration Branch

1001 I Street

Sacramento, California 95814-2828

DPR USE ONLY:

RC# _______________________________

_______________________________

Fee$ ______________________________

_______________________________

RC Date ___________________________

_______________________________

Date Received ______________________

_______________________________

OK by _____________________________

Date Licensed____________________

Returned __________________________

________________________________

Instructions for

APPLICATION TO

AMEND PESTICIDE PRODUCT

DEPARTMENT OF PESTICIDE REGULATION

PESTICIDE REGISTRATION BRANCH (916) 445-4400

DPR-035 (05/06)

Page 2 of 2

INCOMPLETE FORMS WILL NOT BE PROCESSED.

If any section does not apply to your product, please mark it N/A. A separate application form must be completed for each amendment for each product brand name. If you need further assistance, contact the Pesticide Registration Branch at (916) 445-4400.

PRODUCT INFORMATION

1.Firm Name: This must be the same as on file with U.S. EPA.

2.Firm Mailing Address: Correspondence, licenses, notices, etc. will be sent to this address.

4.Name of Authorized Representative: The person who is authorized to answer any questions about your application for registration. Generally, this is the person who prepares the application. If the person is an agent, a letter from the firm authorizing

the agent to act on their behalf is required.

7.E-mail address: In accordance with California Notice to Registrants 2005-4, supplying DPR with this information will automatically enroll the applicant (firm or agent) into the automatic notification program. Applicants that do not wish to receive these automatic email updates must specify this in their cover letter or on the application form.

8.Product Brand Name: This must be EXACTLY the same as the brand name registered (or, if applicable, received) by U.S. EPA and the same as on the product labeling. The product brand name cannot be the same as another product, within the same company, with a different formulation. Do not include symbols used in place of words that are part of the brand name (e.g. @, TM, *, (R), etc.).

9.U.S. EPA Registration Number: Required unless product is exempt from, or does not require, registration under the Federal Insecticide Fungicide and Rodenticide Act (FIFRA) such as spray adjuvant. For a spray adjuvant, the California Registration

Number is required.

10.Type of California Amendment Action Requested:

*Adding sites or uses:

*Adding a crop:

*Adding indoor use:

*Adding the first agricultural use for the active ingredient:

*Adding pests or types of pests not already on the label:

*Reducing the signal word or the precautionary statements:

*Other: Please attach a cover letter explaining the type of registration action requested.

An Amendment Application Package must include the following:

A cover letter describing the type of amendment action requested and what is being submitted to DPR.

A completed “Application to Amend Pesticide Product” form. Make sure your amendment form is complete and signed. Keep a photocopy for your records.

An amendment application fee of $100.00 is required. The fee applies to all amendment actions that must be supported by scientific data, regardless of whether DPR reviews the data. Make check or money order payable to “Department of Pesticide Regulation.” Six (6) copies of the product labeling. Typescript labeling may be submitted if printed labels are not yet available; printer's proofs or final printed labels are required prior to acceptance of the amendment. Copy of U.S. EPA - stamped accepted label, and one copy of the U.S. EPA Notice of Registration, if applicable.

One copy of the data required by California regulations (Title 3 CCR §6170).

If not submitting data, include in your cover letter a reference to specific data on file with DPR or identification of a pesticide product(s) previously approved by the Director that would be subject to some or all of the same data requirements as applicable to the applicant’s product. NOTE: Applicant’s that rely upon data owned by another

company may, pursuant to FAC §12811.5, have certain obligations to the data owner in specifically defined situations. For further information, please refer to <http://www.cdpr.ca.gov/docs/legbills/ab1011/ resource.htm>.

Information Available on the Internet

Information about the California laws and regulations governing pesticide registration, as well as Department notices, policies and procedures is available on the internet at <http://www.cdpr.ca.gov>. Information on currently registered products, registrants, telephone numbers for Department staff, and other information is also available at this site.

Persons interested in receiving notices specific to registration issues must subscribe to the e-mail list or access the “California Notices to Registrants” web page found on the Departments’ website.

To subscribe to “California Notices to Registrants” for e-mail delivery, visit the E-List page at <http://www.cdpr.ca.gov/docs/listserv/listdesc.htm>, and click on the subscribe link under the list name. An alternate method of subscribing is to send an e-mail to canote-request@pestreg.cdpr.ca.gov and put the word “subscribe” in the subject line. You will receive an e-mail, welcoming you to the list. To access new and historical notices via the Internet, see <http://www.cdpr.ca.gov/docs/canot/camenu.htm>.

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Part number 1 for completing California Form Dpr 035

2. After filling in this step, go to the subsequent stage and enter all required particulars in all these blanks - Product Information Product Brand, NOTE Minor amendments not, Signature of Authorized, Type or Print NameTitle, Date Signed, Mail completed application to For, DPR USE ONLY, and RC Fee RC Date Date Received.

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