Epa Form 8570 27 PDF Details

The EPA Form 8570-27, known as the Formulator’s Exemption Statement, plays a critical role in the registration process for certain pesticide products under the regulations set by the United States Environmental Protection Agency (EPA). This form, revised in June 2004, is required for applicants seeking to certify that their product, containing active ingredients already registered under FIFRA Section 3, qualifies for a formulator’s exemption according to 40 CFR 152.85. It meticulously details the necessity for an applicant to affirm that each active ingredient in their product is used solely due to its presence in another registered product from which it was purchased, satisfying the criteria outlined in 40 CFR section 158.50(e)(2) or (3). The form prompts the applicant to provide essential information, including the applicant’s name and address, EPA file symbol/registration number, product name, and the date of the confidential statement of formula, alongside specifying the source of active ingredients via a Confidential Statement of Formula (EPA Form 8570-4) or by affirming that the referenced CSF filed with the EPA is current and accurate. It underscores the significance of accurately documenting the source of active ingredients to maintain compliance with regulatory requirements, ensuring the EPA can efficiently review and process exemption claims. This form also facilitates the reduction of redundant testing and registration, reflecting the EPA’s commitment to streamlining administrative processes while upholding safety and environmental standards. Additionally, it includes a notice regarding the Paperwork Reduction Act, estimating the average time required to complete this form and where to send comments regarding its burden estimate, highlighting the EPA’s efforts to consider and minimize the reporting burden on applicants.

QuestionAnswer
Form NameEpa Form 8570 27
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names8570 27 epa form 8570 27 formulators exemption

Form Preview Example

Form approved. OMB No. 2070-0060, 2070-0057, 2070-0107, 2070-0122, 2070-0164.

United States

Environmental Protection Agency

Washington, DC 20460

Formulator’s Exemption Statement

(40 CFR 152.85)

Applicant’s Name and Address

EPA File Symbol/Registration Number

Product Name

Date of Confidential Statement of Formula (EPA FORM 8570-4)

As an authorized representative of the applicant for registration of the product identified above, I certify that:

(1) This product contains the following active ingredient(s):

(2)Of these, each active ingredient listed in paragraph (4) is present solely as the result of the use of that active ingredient in the manufacturing, formulation or repackaging another product which contains that active ingredient which is registered under FIFRA Section 3, is purchased by us from another person and meets the requirements of 40 CFR section 158.50(e)(2) or (3).

(3)Indicate by checking (A) or (B) below which paragraph applies:

(A) An accurate Confidential Statement of Formula (EPA FORM 8570-4) for the above identified product is attached to this statement.

That formula statement indicates, by company name, registration number, and product name, the source of the active ingredient(s) listed in

paragraph (1).

OR

(B)The Confidential Statement of Formula (CSF)(EPA Form 8570-4) referenced above and on file with the EPA is complete, current, an accurate and contains the information required on the current CSF.

(4)The following active ingredients in this product qualify for the formulator’s exemption.

Source

Active Ingredient

Product Name

Registration Number

Signature

Name and Title

Date

EPA Form 8570-27 (Rev. 06-2004)

Copy 1 – EPA

 

Copy 2 - Applicant copy

Paperwork Reduction Act Notice

The public reporting burden for this collection of information is estimated to average 1.5. hours per response, including familiarization with the form, organizing the necessary information, and completing the form. Send any comments regarding the burden estimate or any other aspect of this collection of information to: Director, Collection Strategies Division (2822T), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, N.W., Washington, DC 20460. Do not send the completed form to this address.

EPA Form 8570-27 (Rev. 06-2004) Reverse Copy 1 - EPA Copy 2 - Applicant copy

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1. While filling in the Epa Form 8570 27, make certain to incorporate all of the important blanks in the relevant form section. It will help facilitate the work, enabling your details to be processed quickly and appropriately.

Completing part 1 of Epa Form 8570 27

2. Just after completing the previous step, go to the subsequent part and complete all required details in all these fields - cid A An accurate Confidential, That formula statement indicates, paragraph, cid B The Confidential Statement, accurate and contains the, The following active ingredients, Active Ingredient, Product Name, Registration Number, Source, Signature, Name and Title, and Date.

Epa Form 8570 27 conclusion process shown (step 2)

3. Within this part, check out Signature, Name and Title, Date, EPA Form Rev, and Copy EPA Copy Applicant copy. Each of these are required to be filled out with utmost accuracy.

Step number 3 for filling out Epa Form 8570 27

Be very careful when completing Copy EPA Copy Applicant copy and Name and Title, as this is where a lot of people make mistakes.

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