Form EPA 747-B-99-002 EPA 747-B-99-002 Application and Instructions for Individuals Applying fo

United States
Environmental Protection
Agency

Office of Chemical
Safety and Pollution
Prevention

EPA 747-B-99-002
April 2009
https://www.epa.gov/lead

Application and
Instructions for
Individuals
Applying for Certification to Conduct
Lead-Based Paint Activities

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Form Approved OMB No. 2070-0155 Expires 10/31/11

APPLICATION FOR INDIVIDUALS
TO CONDUCT LEAD-BASED PAINT ACTIVITIES

U.S. ENVIRONMENTAL PROTECTION AGENCY

Important: Consult the instructions provided for individuals applying for certification to conduct lead-based paint activities to
complete this form. Firms should use the Application for Firms instead of this form. Please type or print responses in black or
blue ink only.
A. General Information (All applicants)
Official Use Only

Select one of the following application types:
Initial certification application
Re-certification application

For information on EPA and other
Lead Programs, see:
http://www.epa.gov/lead

Adding jurisdiction[s] to certification/amending certification
Replacement of a badge
Replacement of a certificate
Replacement of a badge and certificate

Indicate the discipline(s) for which you seek certification or re-certification and all EPA-run jurisdiction(s) in which you intend to
perform lead-based paint activities. For discipline-specific responsibilities, please see the instructions. An EPA-run jurisdiction
includes an EPA-run state, U.S. territory, or all Indian tribal land(s) in any one EPA Region. You will be eligible for certification to
work only in those EPA-run jurisdiction(s) you specify below. Attach additional sheets of paper, as necessary.
The fee you must pay depends on the number of disciplines and EPA-run jurisdiction(s) in which you plan to conduct lead-based
paint activities. See the fees schedule in the instructions to determine your fee. The total fee listed below should include fees
calculated on any additional sheets.
I=Initial

Inspector
I
R

R=Refresher

Supervisor
I
R

Risk
Assessor
I
R

Project
Designer
I
R

Abatement
Worker
I
R

Fee

$

1st EPA-run jurisdiction* (pay base certification
fee only)

$
2nd EPA-run jurisdiction*

Check here if you are listing additional EPA-run jurisdiction[s]
List each additional jurisdiction as necessary. (Each additional jurisdiction is $35 per discipline, per jurisdiction)

$

Certification exam fee ($70 each) (Does not apply to project designers, abatement workers, or applicants applying under Section C). $
Total Fee:

$

*See the definition of EPA-run jurisdiction[s] and the fee examples in the instructions.
For current listing of EPA-run jurisdictions, see www.epa.gov/lead, or call 1-800-424-LEAD.

B. Applicant Information (All applicants)
Check here if you are an employee of a Federally-recognized Indian Tribe.
Mr.

Mrs.

Ms. Name:
Last

First

Middle

Previous and/or Maiden Name(s), if applicable:
Business Phone #:

ext.

Home Phone #:

*In the event that we cannot reach you, please list another contact name and number (optional):

Home Address:
Street Address, Suite Number (Please no P.O. Box)

City

State

Zip Code

City

State

Zip Code

Company Name and Address:
Name

Street Address, Suite Number

Applicant’s E-mail Address (optional):
To which address should correspondence or badge be sent?
EPA Form 8500-27 (Rev 09/04)

Home

Company

Other (please attach)
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Date of Birth:

Race/Ethnicity (optional):
Month/Day/Year

Country of Legal Residence:
Height:

Gender:

Weight:
Feet

Inches

Male

Eye Color:

Female

Hair Color:

Pounds

2”

Submit two identical passport photographs of you alone, recent enough to be a good
likeness (normally taken within the last 6 months). As shown in the example to the right,
photographs should be 2 x 2 inches in size with an image of your head and shoulders taking
up the majority of the area. Photographs must be clear, front view, full face, taken in normal
street clothing without a hat or dark glasses in front of a white or off-white background.
Retouched, digital, and profile images are not acceptable.

C. Reciprocity (Initial Certification applicants only)
Do you hold a current lead-based paint certification
issued by an EPA-authorized state, U.S. Territory, or Indian tribe?

Yes

No
Submit two recent
identical passport photos

If you answered Yes, please complete Section C and skip Sections D and E. Also, attach a
copy of your valid certificate and license. If you answered No, please skip Section C and
complete Sections D and E.

2”

Inspector:

State/Tribe:

Expiration Date:

Supervisor:

State/Tribe:

Expiration Date:

Risk Assessor:

State/Tribe:

Expiration Date:

Project Designer:

State/Tribe:

Expiration Date:

Abatement Worker:

State/Tribe:

Expiration Date:

D. Training (Initial and Re-certification applicants)
Answer the following items about the lead-based paint training course you received for each discipline for which you are seeking
certification or re-certification. Attach additional sheets of paper as necessary.
Discipline:
Name of Training Program:
Name of organization that taught course

Training Program Address:
Street Address, Suite Number

Training Program Phone #:

ext.

City

State

Zip Code

Date Training Completed:
Month/Day/Year

If training was conducted in a language other than English, please specify language:
Training Certificate Identification Number:
Please check the type of test you took:

EPA Form 8500-27 (Rev 09/04)

Course test(s) and/or hands-on assessment

or

Proficiency test

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CERTIFICATION APPLICATION FOR INDIVIDUALS (CONTINUED)

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E. Experience and Education (Initial Certification for Supervisor, Project Designer, or Risk Assessor only)
If applying for Inspector or Worker, go to Section F.
For each discipline, check the combination you are using below:

Supervisor: (A or B must be checked.)
A.

1 year experience as certified lead abatement worker

B.

2 years experience in building trades or related field*

*Examples of related fields include lead, asbestos, environmental remediation work, or construction.

Project Designer (A or B must be checked.)
A.

Bachelors degree in engineering, architecture, or
related profession, AND
1 year experience in building construction and design
or related field*

B.

4 years experience in building construction and design
or related field*

*Examples of related fields include lead, asbestos, environmental remediation work, or construction.

Risk Assessor: (A, B, C or D must be checked.)
A.

Bachelors degree AND
1 year experience in related field*

C&Hrtification as industrial hygienist, professional
engineer, registered architect, OR

B. $VVRFLDWHVGHJUHH$1'
\HDUVH[SHULHQFHLQDUHODWHGILHOG
D.

High School/GED AND
3 years experience in related field*

Certification in related engineering/health/environment
field (e.g., safety professional, environmental scientist)
*Examples of related fields include lead, asbestos, environmental remediation work, or construction.

For experience combinations checked above, answer each of the following (Attach additional sheets of paper, as necessary):
Requested Discipline:

Current Occupation Title:

Dates employed:

Documentation attached:

Company Name:
Resume

Reference Letter

Summary of work

For education checked above, answer each of the following (Attach additional sheets of paper, as necessary):
School:

Major/Course of study:

Documentation attached:

Diploma

Degree:

Year:

Transcript

F. Lead-Based Paint Activity Violations (All applicants)
Do you have any past, present, or pending lead-based paint activity violations

Yes

No

If yes, please attach a written explanation.

G. Additional Information (All applicants)
Use the following space for any additional information or comments that you feel are relevant and want EPA to consider with your
application. Attach additional sheets of paper, as necessary.

EPA Form 8500-27 (Rev 09/04)

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CERTIFICATION APPLICATION FOR INDIVIDUALS (CONTINUED)

Form Approved OMB No. 2070-0155 Expires 10/31/11

H. Signature (All applicants)
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 in
target 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 relevant to that responsibility; 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.

Please sign your name and write the date in the blanks below if you understand and agree with the following statement:
I hereby attest and affirm that the information included on this application, including any attachments, is true and
accurate to the best 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 certification. I also attest and affirm that I will maintain my
certification(s) according to 40 CFR § 745.226, follow work practice standards according to 40 CFR § 745.227, and
conduct lead-based paint activities only in those disciplines and geographical areas in which I have received
certification.

Date Signed
Applicant’s Signature
(Please sign legibly within the boundaries of the box above.)

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 two identical passport photos of yourself
Enclosed a copy of your course completion certificate(s) Enclosed documentation of your education, experience, and
professional certification(s), if necessary
Enclosed any other documentation needed -- see the instructions for more information
Enclosed the appropriate certification fee(s)(check or money order)
Printed “Lead Program User Fees” on the check or money order
Submitted $70 certification exam fee if applying for initial certification for Inspector, Supervisor, or Risk Assessor
For more information, see the fees section in the instructions
Mail the 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

EPA Form 8500-27 (Rev 09/04)

Page 4 of 4

INSTRUCTIONS FOR INDIVIDUALS APPLYING FOR CERTIFICATION
TO CONDUCT LEAD-BASED PAINT ACTIVITIES
You may apply to the U.S. Environmental Protection Agency (EPA) to be certified or re-certified to conduct
lead-based paint activities as an Inspector, Supervisor, Risk Assessor, Project Designer, or
Abatement Worker 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 you wish to work, you must apply directly to that state, territory, or Indian tribe
for certification.
These instructions supplement EPA form 8500-28 (Rev 09/04), Application for Individuals to Conduct
Lead-Based Paint Activities. Please note that you must use a separate application form for each
application type. For example, if you are applying for initial and re-certification in two disciplines, you must
use two separate application forms.
Responsibilities of Certified Disciplines
Discipline
Inspector

•
•

Responsibilities
Inspection
Post-abatement clearance

Supervisor

•
•
•

Occupant protection plan
Abatement report
Oversee abatement activities

Risk Assessor

•
•
•
•

Inspection
Lead hazard screen
Risk assessment
Post-abatement clearance

Project Designer

•
•

Occupant protection plan
Abatement report

Abatement Worker

•

Conduct abatement activities

How to Apply for Initial Certification
If You Are Currently Certified
To apply for certification from EPA if you are currently certified by an authorized state, U.S. territory,
or Indian tribe, you must:
•
•
•

•
•

Complete, sign, and date EPA form 8500-28 (Rev 09/04).
Enclose a copy of your valid certificate from an authorized state, U.S. territory, or Indian tribe,
highlighting the certification expiration date, if applicable.
Submit two identical passport photographs of you alone. Photographs must be:
o Recent enough to be a good likeness (taken within the last 6 months);
o Clear with a front view of your face taking up the majority of the area (hats or dark glasses
are not acceptable);
o Focused on your head and shoulders; and
o Printed from film with dimensions of 2 x 2 inches. Retouched, digital, and profile images
are not acceptable.
Calculate the appropriate fee using the fees schedule provided.
Print “Lead Program User Fees” on the check or money order for the fee and mail it with your
application to the address at the bottom of this page.

If You Are Not Currently Certified
To apply for certification from EPA if you have successfully completed an EPA-accredited training
course, you must:
•
•

•
•

Complete, sign, and date EPA form 8500-28 (Rev 09/04).
Submit two identical passport photographs of you alone. Photographs must be:
o Recent enough to be a good likeness (taken within the last 6 months);
o Clear with a front view of your face taking up the majority of the area (hats or dark glasses
are not acceptable);
o Focused on your head and shoulders; and
o Printed from film with dimensions of 2 x 2 inches.
Retouched, digital, and profile images are not acceptable.
Calculate the appropriate fee using the fees schedule provided.
Print “Lead Program User Fees” on the check or money order for the fee and mail it with your
application to the address below:
U.S. EPA
Lead User Fees
P.O. Box 979072
St. Louis, MO 63197-9000

Certification of Tribal Employees
Individuals seeking certification or re-certification under the tribal fee allowance must currently be in the
employment of a Federally-recognized Indian Tribe. In Section B check the tribal employment box and in
the company name and address field provide the name and address of the tribal government you are
currently working for to verify employment.

Discipline-specific Requirements
The information you must submit depends on the discipline(s) for which you seek certification. The
following table identifies these requirements.
Discipline

Application Sections

Inspector

A, B, C or D, F, G, and
H

Supervisor

A, B, C or D and E, F,
G, H

Required Documentation
•

Valid inspector course completion certificate (Section D) or
valid certificate and license (Section C)

•

Valid supervisor course completion certificate (Section D)
or valid existing certificate and license (Section C)
Resume(s), letters of reference, etc.

•
•

Risk Assessor*

A, B, C or D and E, F,
G, H

Project Designer

A, B, C or D and E, F,
G, H

Abatement Worker

A, B, C or D, F, G, and
H

•
•
•
•
•
•
•

Inspector course and valid risk assessor course
completion certificates (Section D) or valid certificate and
license (Section C)
Resume(s), letters of reference, etc.
Official high school diploma or college transcript
Professional certification(s)
Supervisor course and valid project designer course
completion certificates (Section D) or valid certificate and
license (Section C)
Resume(s), letters of reference, etc.
Official college transcript
Valid worker course completion certificate (Section D) or
valid certificate and license (Section C)

How to Apply for Re-certification
If you completed an accredited training course with a course test and, if applicable, a hands-on
assessment, you must be re-certified every three (3) years. If you completed an accredited course that
included a proficiency test, you must be re-certified every five (5) years (all disciplines except Project
Designer).
You may take a refresher course accredited by either EPA or an EPA-authorized training program. To
ensure that you will be re-certified before your current certification expires, you should submit your recertification application well before your expiration date.
For re-certification, complete all sections except for sections C (Reciprocity) and E (Experience and
Education) of the application and follow the mailing instructions described in the “initial accreditation”
section of these instructions. Also submit two recent, identical passport photographs that meet the criteria
outlined on the application.
Amended Application
Amended applications must be sent to the following address:
U.S. EPA
P.O. Box 14417
Washington, DC 20044-4417

Replacement of an Identification Badge or Certificate
To replace an identification badge or certificate, complete only sections A (General Information), B
(Applicant Information), and H (Signature) of the application and follow the mailing instructions described
in the “initial accreditation” section of these instructions. For badge replacement only, also submit two
recent, identical passport photographs that meet the criteria outlined on the application.
Incomplete Application
If your application is incomplete, EPA will not process your 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 see if your
application is complete.
Fees
The fee for applying for certification, re-certification, and other requests is listed on the following page. It is
important that you:
•

Calculate the fee based on the number of disciplines and number of EPA-run jurisdiction(s) in which
you plan to work.

•

Submit one $35 fee for all Indian tribal land(s) in any one EPA Region, if you are applying for
certification in multiple Indian tribal lands.

•

Include a list of the disciplines and EPA-run jurisdiction(s) with your fee, if you are applying for
certification in more than one discipline.

•

Write your total fee amount in section A of the application, even if you attach additional sheets of
paper listing additional EPA-run jurisdictions.

•

Include the certification exam fee (if applicable) with the certification fee, for more efficient processing.

•

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

Initial Certification Fee

Re-certification Fee
[every 3 or 5 years, see 40
CFR 745.226(e)(1)]

$410

$410

$310

$310

$10

$10

Individual, all disciplines except
abatement worker (inspector,
supervisor, risk assessor, project
designer)
Individual Abatement Worker
Tribal Individual, all disciplines
Certification examination Fee*

$70 for each attempt

Multi-jurisdictional Certification Fee**

$35 per discipline for each additional EPA-run jurisdiction***

Replacement Identification Badge

$15

Replacement Certificate

$15

*Does not apply to project designers, abatement workers, or applicants applying under section C of the application (reciprocity).
**Multi-jurisdictional certification applies to an applicant applying in more than one EPA-run jurisdiction.
***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 Examples
1) If applying for initial Risk Assessor certification in one state:
Initial Risk Assessor certification fee
Certification exam fee for Risk Assessor
Total Amount Due:

$ 410
$ 70
$ 480

2) If applying for initial Risk Assessor and initial Abatement Worker certifications in two states:
Initial Risk Assessor certification Fee
Certification exam fee for Risk Assessor
Initial Worker certification fee (no exam fee)
One additional state fee* (2 disciplines)
Total Amount Due:

$ 410
$ 70
$ 310
$ 70
$ 860

3) If applying for initial Project Designer and initial Supervisor certifications in two states and all Indian
tribes in one EPA Region:
Initial Project Designer certification fee (no exam fee)
Initial Supervisor certification fee
Certification exam fee for Supervisor
One additional state fee* (2 disciplines)
All Indian tribes in one EPA Region fee* (2 disciplines)
Total Amount Due:
*Each certification request includes the fee for one EPA-run jurisdiction.

$ 410
$ 410
$
70
$
70
$
70
$ 1,030

EPA’s Certification Fees Refund Policy
Individuals having submitted an application and associated fees for certification or recertification who wish
to withdraw their application prior to Agency approval will receive a fee refund based upon the schedule
listed below. Individuals 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 for a particular
discipline)

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. Treasury.
Individuals 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 an applicant certification or re-certification. Refunds are granted
only on a per discipline basis. Therefore, an individual must withdraw an application for a particular
discipline in all EPA-run jurisdiction(s) included on the application. If your application is disapproved, EPA
will not refund fees.
Refunds are not available for certification examination fees or for the replacement of an identification
badge or certificate.

Application Process
EPA processes applications on a first-come first-served basis. Your course completion certificate will
serve as interim certification for six months. If the application process is not completed within 6 months of
your course completion, the initial training must be retaken and the application process restarted including
paying the certification fee again. To make sure to allow enough time for your application to be processed,
you should submit your application for certification to EPA within 30 days of completing your initial training
course. If you are applying for supervisor, inspector, or risk assessor certification, you must pass a 3rd
party exam and receive certification from EPA before the expiration date on your interim certification. If
you do not complete these activities before the expiration date, you cannot conduct lead-based paint
activities.
If you are applying for re-certification, your application should be submitted well before your certification
expires in order to allow time for processing. You do not need to take the certification exam again to be recertified.
If a firm is assisting in completing applications for individuals who are applying for certification,
please be aware of the following:
•

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

•

Individual must sign and date the application.

•

Individual’s name, social security number, 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.

•

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.

The flowchart on the following page depicts the application process for individual certification.

Application Process for Individual Certification

Paperwork Reduction Act Notice: The annual public burden for this collection of information is estimated to be 1 hour for inspectors, risk assessors and
supervisors, and 0.5 hours for workers and project designers per response, 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.