8570-30 Pesticide Registration Maintenence Fee Filing Form

Please read Paperwork Reduction Act Notice in instructions.

Form Approved.

OMB No. 2070-0179.

United States Environmental Protection Agency

EPA

Pesticide Registration Maintenance Fee Filing Form

A. Registrant Identification:
2020 PESTICIDE PRODUCT MAINTENANCE FEE

Please enter address correction here:

B. EPA Company Number(s):
C. Maintenance Fee Calculation:

Table to be Used (Circle One): Table A

Table B

Table C

Financial data required to use Tables B and C.

1. Number of registrations on printout you will support by paying the fee:

______________

2. Number of registrations on printout already approved by EPA for transfer to another registrant:

______________

3. Number of registrations on printout previously canceled, or which you want EPA to cancel:

______________

4. Number of registrations on printout not counted in lines C1, C2, or C3:

______________

5. Number of active registrations omitted from the printout you will support by paying the fee:

______________

6. Total number of registrations you will support by paying the fee (C1 + C5):

______________

7. Amount due (See fee table in instructions. If using Table B or C, documentation required.):

$ ______________

8. Pay.gov Tracking ID or Electronic Transfer Ref. No. w/date (Checks no longer accepted.):

______________

Important! Registrations For Which The Fee Is Not Paid
Will Be Canceled!
For the Maintenance Fee instructions, go to www.epa.gov/pesticide-registration/annual-pesticide-registration-maintenance-fees or go to
www.epa.gov/pesticides then A-Z Index under Tools, M and then Maintenance Fees.

D. Authorized Company Representative or Agent:
I certify that the statements that I have made on this form and all attachments thereto are true, accurate, and complete. I acknowledge that any knowingly
false or misleading statements may be punishable by fine or imprisonment or both under applicable law.
Name

Signature and Date

Title

Telephone

Send Filing Form, Annotated Printout and
payment receipt either via U.S. Postal Service
(including Express Mail) to:

or via Fed Ex, UPS, courier, etc., to:

U.S. Environmental Protection Agency
Office of Pesticide Programs (7504P)
Document Processing Desk (MFEE)
1200 Pennsylvania Ave., N.W.
Washington, D.C. 20460-0001

Email

U.S. Environmental Protection Agency
Office of Pesticide Programs (7504P)
Document Processing Desk (MFEE)
Room S-4900, Potomac Yard One
2777 South Crystal Drive
Arlington, VA 22202
Please send to only one of the addresses based on the method of shipment.

EPA Form 8570-30 (Rev. 08-07)