Form Dp 21 – Fill Out and Use This PDF

Instructions for the Arkansas Application for Registration of Pesticides (DP-21 (Rev. 9/10)) form This form is for Registration of products that are not listed on the DP-21R (Rev. 9/10):

1.Indicate calendar year ending December 31.

2.AClass@ and AProduct Number@ columns: Do Not Write In This Space!

3.AComplete Brand and Name of Pesticide@ column: Indicate complete Brand and name of pesticide.

Registrants desiring to discontinue a product registration should be aware that Arkansas requires a two-year discontinuance. The ASPB will also accept a letter stating there is no product within the channels of trade in lieu of the discontinuance period. The registrant should be certain that there is, in fact, no product within the channels of trade before submitting such a letter. Arkansas State Law holds the registrant responsible for any unregistered product found within the channels of trade.

Please indicate AD-1" for first year discontinuance or AD-2" for second year discontinuance or AOTC@ for out of channels of trade next to the product name.

4.AAPD Fee Exempt@ column: Please indicate AY@ if a product is exempt or AN@ if a product is not exempt

Arkansas requires a $50.00 Abandoned Pesticide Disposal (APD) Fee for some products. This disposal fee does not apply to 1) Sanitizers and Disinfectants, 2) Aerosol products which are not labeled for agricultural use, 3) Insect repellants which are labeled for use on the human body or clothing, 4) Silica gels and other non-volatile ready-to-use paste, foam or gel formulations of insecticidal baits, 5) Non-volatile insecticidal baits in tamper resistant bait stations, 6) Insecticidal flea and tick collars and spot-on flea treatments for dogs and cats, and 7) Insecticidal cattle ear tags. Registrants must indicate on the Application for Registration of Pesticides (DP-21 (Rev. 9/10)) that their product is exempt under this column in order to avoid paying the APD Fee. Registrants who do not indicate an exemption under this column are expected to pay the $50.00 APD Fee in addition to the full $250.00 registration fee.

5.AEPA Registration Number@ column: Indicate complete EPA Registration Number

6.ACategory@ column: Do Not Write In This Space!

7.ATotal Fee enclosed@: Please indicate the total amount of fees.

$	250.00 Registration Fee per product
$	50.00 APD Fee per product, if not exempt.

8.ACompany Name, mailing address, City and State, Signature, Printed Name Title, Date of Application, Telephone

Number and Fax Number@: Please complete for each page accordingly. Make copies of the page before Signing, then Original signatures are needed on the original and copy submitted. Once approved, the copy will returned for your records.

Submit the completed DP-21 (Rev. 9/10) in duplicate to the STATE PLANT BOARD, P.O. BOX 1069, LITTLE ROCK, AR 72203 with the following required attachments:

-Check payable to State Plant Board for the total amount of fees

-One copy of a complete product label (8 2 x 11, or folded to such size), in order to correspond to the products listed on the application, for each product.*

-PDF format of a complete product label. The electronic document name needs to include the complete product name and the EPA Registration Number, and the document needs to be readable when printed. Labels may be submitted on a CD or emailed to brandi.reynolds@aspb.ar.gov.

-Out of channels of trade letter if applicable.

*(Registrants are only required to submit labels if the product is new to Arkansas or the label has been changed since the product was last registered in Arkansas)