2507-01 Attachment 4

United States
Environmental Protection
Agency

Office of Chemical
Safety and Pollution
Prevention

EPA 8500-27
January 2013
http://www.epa.gov/lead

Application and
Instructions for Firms

Applying for Certification to Conduct Lead-Based
Paint Activities and/or Renovations

[This page intentionally left blank]

Form Approved OMB No. 2070-0155 Expires 12/31/15

U.S. ENVIRONMENTAL PROTECTION AGENCY

APPLICATION FOR FIRMS
TO CONDUCT LEAD-BASED PAINT ACTIVITIES AND/OR RENOVATIONS

Important: This application is required by 40 CFR §745.89(a) for renovations and is a substitute for the letter required by
§745.226(f)(2) for abatement. Consult the instructions for firms applying for certification to conduct lead-based activities or renovations.
For abatement activities, persons seeking individual certification should use the Application for Individuals instead of this form. Please
fill out all sections. Type or print responses in black or blue ink only.
A.

Application Type (select only one box from Option 1, 2, 3 or 4 of Section A)
1.

2.

3.

Option 1: Renovation, Repair, and Painting (RRP and Dust Sampling Technician) Firm Certification
Initial
Recertification
or
Renovation, Repair and Painting Firm Certification ($300)
or
Option 2: Abatement (Abatement, Risk Assessment, and Inspection) or Abatement/RRP Combination Firm Certification
Initial
Recertification
or
Abatement Firm Certification ($550 for first jurisdiction and
$35 for each additional jurisdiction – list jurisdiction(s) below)
Initial
Recertification
or
Combination Abatement/RRP Firm Certification ($550
for RRP and one abatement jurisdiction, $35 for each
additional abatement jurisdiction – list abatement jurisdiction(s) below)
List abatement jurisdiction(s):
1)___________________ ($550) 2) ____________________ ($585) 3) ____________________ ($620)
(Please note, if applying for more than three jurisdictions add an additional $35 for each jurisdiction and list them on a
separate sheet of paper)
or
Option 3: Amend Existing Certification
Update firm information (no fee required)

Add abatement jurisdiction ($35 per abatement jurisdiction)
List abatement jurisdiction(s) being added to your existing certification:
1) ____________________($35) 2) __________________($70) 3) ________________($105)
or

4.

Option 4: Replace Certificate
Replace Certificate ($15)

B. Enter total application fee $_________________________
Note 1: See instructions for additional fee information and examples of required fees.
Note 2: If you are a federally recognized Indian Tribe seeking certification as a firm check yes in the question below and see Fees
Schedule in the instructions to determine fee required.
Yes
No
Indicate whether you are a federally-recognized Indian tribe seeking certification as a firm.
C. Applicant Information
Name of Firm:
Business Address:

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

Mailing Address:

(if different from above) Street Address, Suite Number

Name of Attesting Individual:
Firm’s Phone #:

Last

ext #:

City

State

Zip Code

City

State

Zip Code

First

Attesting Individual’s Phone #:

Middle

ext.

Attesting Individual’s E-mail Address:
EPA Form 8500-27 (Rev 1/13)

Page 1 of 2

Form Approved OMB No. 2070-0155 Expires 12/31/15

D. Website Listing
Once certified your firm will be listed on EPA’s web based search tool. Please select the type of service(s) your firm will
provide:
Renovation
Evaluation
Lead Abatement
E. Lead-Based Paint Activity or Renovation Violation[s]
Does the firm have any past, present, or pending lead-based paint violations of EPA,
State, U.S. territory, or Indian tribal land(s) regulations? If yes, please attach a written explanation.

Yes

No

F. Certification Statement
I hereby attest and affirm the following:

The information included on this application, including any attachments, is true and accurate to the best of my belief and
knowledge.

This firm shall only employ appropriately qualified individuals to conduct lead-based paint activities and renovations.

This firm and its employees shall follow the work practice standards set forth in 40 CFR § 745.227 for conducting lead-based
paint activities or 40 CFR § 745.85 for conducting renovations at all times.

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.

____________________________________________
Attesting Individual’s Signature

__________________________/_____/_______
Title
Date Signed

(Please sign legibly within the boundaries of the box above.)

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 and renovations 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.

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 the appropriate certification fees (check or money order)


Make check payable to U.S. EPA



Printed “Lead Program User Fees” on the check or money order



For more information, see the fees section of the instructions

Mail 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 1/13)

Page 2 of 2

INSTRUCTIONS FOR FIRMS APPLYING FOR CERTIFICATION TO CONDUCT LEAD-BASED
PAINT ACTIVITIES AND RENOVATIONS
Firms must apply to the U.S. Environmental Protection Agency (EPA) to be certified (or recertified) to
perform renovations, post-renovation dust sampling, or lead-based paint activities (abatement, inspection,
or risk assessment), in states, U.S. territories, and all Indian tribal lands administered by EPA. If EPA
does not administer the certification program in an area where a firm wishes to work, the firm must apply
directly to that state, territory, or Indian tribe for certification. To find out which states are administered by
EPA go to website listed below or call the National Lead Information Center at 1-800-424-LEAD (5323):
 For renovation, repair, or painting work (including dust sampling), visit EPA’s web page at
http://www.epa.gov/lead/pubs/lscp-renovation_firm.htm
 For abatement, inspection or risk assessment, visit EPA’s web page at
http://www.epa.gov/lead/abatement.html
Within 90 days of receiving a complete request for certification, EPA will approve or disapprove the
application. To expedite this process, it is recommended that you submit your application online as
instructed below.
These instructions supplement OMB approved form No. 2070-0155, Application and Instructions for
Firms. Please note that you must apply separately for each application type (i.e., initial certification, recertification, amending certification, adding jurisdictions, or replacement of a certificate).
How to Apply for Initial Certification
Firms may submit their application and payment online or by mail:







Online:
Go to www.epa.gov/lead/lscp-renovation.html
If you have not registered in the Agency’s CDX system previously, you will be required to register.
Once registered, log in, complete the application form, and submit payment online following
instructions provided.
By mail:
Complete, sign, and date EPA form 8500-27 (Rev 09/11). The form can be filled out by hand or
by using a fillable form on your computer (www.epa.gov/lead/pubs/firmapp.pdf). Calculate the
appropriate fee using the fees schedule provided in these instructions.
Make your check or money order payable to U.S. Environmental Protection Agency, also print
“Lead Program User Fees” on the check or money order for the fee and mail it with your
application to the following address:
U.S. EPA
Lead User Fees
P.O. Box 979072
St. Louis, MO 63197-9000

How to Apply for Re-certification
Firms must be re-certified every five (5) years for renovations and three (3) years for lead-based paint
activities (abatement, inspection, risk assessment). You must be recertified by EPA before your current
certification expires. EPA therefore recommends that you apply for recertification at least 90 days before
your current certification expires. Re-certification can be completed online or by mail. Follow the
instructions described in the “Initial Certification” section of these instructions to submit your application.
Be sure to complete all sections of the application.
Combined Applications
Firms can apply for certification under the Renovation, Repair, and Painting Rule and Lead-based Paint

Activities Regulations (abatement, inspection, risk assessment) in a single application for a single fee of
$550. For Tribal government entities, the fee is $20. Firms that apply for these certifications separately
will have to pay the appropriate fee for each. The lower fee only applies if a single firm seeks both
certifications, for a State or Tribe where EPA implements both programs, in one application.
Note: Firms may only apply to the U.S. Environmental Protection Agency (EPA) to be certified (or
recertified) to perform renovations, post-renovation dust sampling, or lead-based paint activities
(abatement, inspection, or risk assessment) in states, U.S. territories, and all Indian tribal lands
administered by EPA. If EPA does not administer the certification program in an area where a firm
wishes to work, the firm must apply directly to that state, territory, or Indian tribe for certification. To find
out which states are administered by EPA go to website listed below or call the National Lead Information
Center at 1-800-424-LEAD (5323):
 For renovation, repair, or painting work (including dust sampling), visit EPA’s web page at
http://www.epa.gov/lead/pubs/lscp-renovation_firm.htm
 For abatement, inspection or risk assessment, visit EPA’s web page at
http://www.epa.gov/lead/abatement.html#b
Amended Application
Any change to the information reported to EPA in a firm's most recent certification application must be
reported in an amended certification application. There is no cost associated with the submission of an
amended certification.
Amended applications can be completed online or by mail. Follow the instructions described in the “Initial
Certification” section of these instructions to submit your application online. Amendments by mail should
be sent to the following address:
U.S. EPA
P.O. Box 14417
Washington, DC 20044-4417
Replacement of a Certificate
There is a fee of $15 to replace a certificate. The request for replacement can be completed online or by
mail. Follow the instructions described in the “Initial Certification” section of these instructions to submit
your request online. If requesting by mail complete only sections A (Application Type), B (Application
Fee), C (Applicant Information) and F (Certification Statement) of the application and follow the mailing
instructions described in the “Initial Certification” section of these instructions.
Incomplete Application
If any components of your application are missing, your application will become inactive and you will be
given 30 days to submit the needed materials. If you do not complete your application within the 30-day
period, EPA will return the application package. You may apply again with a complete package, including
fee. You may call 1-800-424-LEAD to find out if your application is complete.
Firms Completing Applications for Individuals Under Lead-based Paint Activities (Abatement,
Inspection, Risk Assessment)
If the firm is assisting in completing applications for individuals who are applying for certification for leadbased paint activities, please be aware of the following:
 Individuals must have an address and phone number different from the firm’s.
 Individuals must sign and date the application.
 The individual’s name 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, including approval and certificates, to individuals who have
signed the application attesting to their willingness to comply with the work practice standards
found at 40 CFR §745.227 and/or at 40 CFR §745.85.



EPA can forward 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.

Fees
The fee for applying for certification, re-certification, and other requests is listed in the following schedule.
 If you apply online your fee will be calculated for you based on the fee schedule below.
 If you apply by mail, it is important that you:
o Calculate fee based on the number of EPA-run jurisdiction(s) in which you plan to
operate.
 If applying for lead RRP certification, there is NO jurisdictional fee – the
certification or re- certification fee is a national certification which covers all
jurisdictions where EPA administers the program.
 If applying for lead-based paint activities certification (abatement, inspection,
risk assessment), submit a $35 dollar fee each additional EPA-run state or
territory, or all Indian tribal land[s] located in each EPA Region, (e.g., if applying
for certification in multiple Indian Tribal lands located in Region 5 and Region 7
you must pay a $35 fee per Region, or a total of $70).
o Write your total fee amount in section B of the application, even if you attach additional
sheets of paper listing additional EPA-run jurisdictions.
o Make the check or money order payable to U.S. Environmental Protection Agency.
Fees Schedule
Description

Fee

Replacement Certificate

$15

Renovation Firm Certification

Certification

Recertification

Firm

$300

$300

Tribal Firm

$20

$20

Combined Renovation and Lead-based Paint
Activities Firm Application

$550

$550

Combined Renovation and Lead-based Paint
Activities Tribal Firm Application

$20

$20

Lead-based Paint Activities Certification
(Abatement, Inspection, Risk Assessment)

Certification

Recertification

Firm

$550

$550

Tribal Firm

$20

$20

Combined Renovation and Lead-based Paint
Activities Firm Application

$550

$550

Combined Renovation and Lead-based Paint
Activities Tribal Firm Application

$20

$20

Multi-jurisdictional Certification Fee*

$35 for each additional EPA-run jurisdiction**

*Multi-jurisdictional certification applies to lead-based paint activities (abatement, inspection, risk
assessment) for an applicant applying in more than one EPA-run jurisdiction. This fee does not apply to
renovation firm certification.
**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 http://www.epa.gov/lead/abatement.html#b
or call 1-800-424-LEAD.)

Fee Example
If your firm is applying for initial certification for lead-based paint activities (abatement, inspection, risk
assessment) in two states and all Indian tribal land(s) in any one EPA Region, your firm is required to pay
$620:
Initial lead-base paint activities (abatement, inspection, risk assessment)
firm certification fee
One additional state fee*
All Indian tribes in one EPA Region fee*
Total Amount Due:

$550
$ 35
$ 35
$620

If your firm is applying for initial certification to conduct renovations and intends to work in multiple states,
your firm is required to pay $300:
Initial renovation firm certification fee
Additional jurisdiction fee does not apply to renovation certification
Total Amount Due:

$300
$ 0
$300

If your firm is submitting a combined application for initial certification in lead-based paint activities
(abatement, inspection, risk assessment) and renovation, your firm is required to pay $550:
Initial combined certification fee for lead-based paint activities (abatement, inspection, risk assessment)
and renovation
$550
Total Amount Due:
$550
*Each certification request for lead-based paint activities (abatement, inspection, risk assessment)
includes the fee for one EPA-run jurisdiction. The multi-jurisdiction fee does not apply to renovation
certification.
EPA’s Certification Fees Refund Policy
Firms having submitted an application and associated fees for certification or re-certification who wish to
withdraw their application prior to Agency approval will receive a fee refund based upon the schedule
listed below. Firms who request a refund more than 10 days after the Agency receives the
application will receive only a partial refund.
Number of Days Following
Agency Receipt of Application

Percent Reimbursable
(based upon total fees submitted)

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.
Firms 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 a firm certification or re-certification. If your application is
disapproved, EPA will not refund fees.

Refunds are not available for replacing a certificate.
Refund and withdrawal requests must be sent to the following address:
U.S. EPA
P.O. Box 14417
Washington, DC 20044-4417
Application Process for Firm Certification
EPA processes applications on a first-come, first-served basis. To expedite this process, it is
recommended that you submit your application online. The following flowchart depicts the application
process for firm certification. EPA has up to 90 days after receiving a complete request for certification to
approve or disapprove the application.

Firm submits application and fee to EPA
Firm submits missing information
Is the
application
complete?

No

EPA contacts
applicant regarding
missing information

Yes

Is the applicant
qualified?

No

EPA returns
application with an
explanation of
deficiency

Yes

EPA sends approval
letter and certificate

Paperwork Reduction Act Notice: The annual public burden for this collection of information is estimated to be 7.5 hours for firms,
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.