Attachment E - Form 3540-01

OMB Control No. 2070-0020
Expires on MM/DD/YYYY

United States

ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460
Notice of Arrival of Pesticides and Devices
Send Completed Form to Appropriate Regional Office Listed in the Instructions for this Form.
Note: Read Instructions before completing form.
Part 1: To Be Completed by Importer of Record or Licensed Customs Broker
1. Name and Complete Address of Licenced Customs Broker

Return Form to this Address

2. Name and Complete Address of Importer of Record

Return to this Address

3. Name and Complete Address of Shipper

4. EPA Registration Number

5. EPA Producer Establishment No.

6. Brand Name of Product

7. Active Ingredients and Percentage of Each

8. Unit Size

9. Quantity

10. Total Net Weight

12. Port of Entry

14. Entry Number

11. Country of Origin

13. Name and Complete Address of Carrier

15. Anticipated Entry Date

17. Location of Goods for Examination after Importation

16. I assert that information constituting Confidential Business
Information is shown in the above blocks numbered: (Note: Blocks
4, 5, 6 and 7 are not entitled to CBI treatment--see instructions.)

18. [Optional] For pesticides without an EPA Registration No., select all that apply: (The following information may expedite the
processing of the Notice of Arrival.)
18a. A pesticide transferred between registered establishments operated by the same producer. Domestic Producer Establishment
Number:
18b. A pesticide transferred between registered establishments not operated by the same producer. Domestic Producer Establishment Number:

EPA Registration Number of Product being Formulated, if applicable:

18c. A pesticide distributed under an Experimental Use Permit. Experimental Use Permit Number:
EPA Form 3540-01 (Rev. 10/20) Previous versions are obsolete.

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EPA Registration Number:

Product Name:

Total Net Weight:

Entry Number:

18d. A Pesticide distributed for research and development purposes without an Experimental Use Permit.
18e. A pesticide transferred solely for export. Domestic Producer Establishment Number:
18f. A pesticide distributed under an emergency exemption. Emergency Exemption Number:
18g. A pesticide transferred for the purposes of disposal.
18h. Other. Provide an explanation including the intended use and a description of why the product is being imported into the United
States in Block 19 -- Remarks.
19. Remarks. Provide additional information here. It is recommended that a copy of the label affixed to the product be submitted with
the NOA.

Certification
I certify that the statements I made on this form and all attachments thereto are true, accurate and complete. I acknowledge that any
knowingly false or misleading statement may be punishable by fine or imprisonment or both under applicable law.
20. Printed Name of Importer of
Record or Licensed Customs Broker

Telephone No.:

21. Signature of Importer of Record
or Licensed Customs Broker:

Date:

Part II: To Be Completed by U.S. Environmental Protection Agency
Action to be taken by U.S. Customs and Border Protection:
Release Shipment
Other.

Detain for inspection

Release shipment to consignee under bond. Shipment must be held intact pending
inspection.

(Specify)

Remarks:

Signature and Title
of EPA Official:

Date:
Part III: To Be Completed by U.S. Customs and Border Protection

The information shown in Part I was compared with the entry papers for this shipment and no discrepancies were noted. The shipment
was handled as instructed by EPA in Part II. Any deviations should be brought to the attention of EPA before releasing the shipment and
should be noted in "Remarks."
Remarks:

Signature of District
Director of Customs:

Date:

Paperwork Reduction Act Notice: “This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No.
2070-0020). Responses to this collection of information are mandatory (19 CFR 12). An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is
estimated to be approximately 26 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and
any suggested methods for minimizing respondent burden to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania
Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.”
EPA Form 3540-01 (Rev. 10/20) Previous versions are obsolete.

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Instructions
U.S. Customs and Border Protection (CBP) Regulations. 19 CFR 12.112 requires an importer desiring to import pesticides or devices
into the United States to submit EPA Form 3540-1, Notice of Arrival of Pesticides and Devices (NOA) to the U.S. Environmental Protection
Agency (EPA) prior to the arrival of the shipment in the United States. The NOA will be used by:
1. Importer of Record or Licensed Customs Broker: The importer of record or licensed customs broker must complete Part I of the
NOA form. A separate NOA must be submitted for each pesticide or device in each shipment prior to its arrival at the port of entry. To
expedite the handling of pesticide or device shipments, submit NOA(s) to the EPA office listed below having jurisdiction over the
state/territory of the port of entry. It is recommended that all applicable blocks in Part I be completed prior to submission to EPA, and
that a copy of the label affixed to the product be submitted with each NOA. Additional supporting documentation (e.g. CBP Form
7501, 3461, or 3461 ALT) for validating information provided may also be included with the submission. When providing an address,
the complete address should include the mailing location, e-mail address, and telephone number of the contact person.
2. EPA: EPA will complete Part II, indicating the disposition of the shipment, sign and return the NOA(s) to the importer or agent for
presentation to CBP at the time of entry.
3. CBP: CBP will compare the information shown on the NOA(s) with the entry documents and the shipment, bringing any
discrepancies to EPA's attention before the shipment is released, and noting discrepancies in the Remarks section. If the importation
is not handled by CBP in the manner instructed in Part II, this should also be noted in the Remarks.
1. Name and Complete Address of the Licensed Customs Broker. Person (such as private individual, partnership, association or
corporation) who is licensed, regulated and empowered by CBP to assist and transact on behalf of others (importers and exporters) in
meeting Federal requirements governing imports and exports (customs business).
2. Name and Complete Address of the Importer of Record. Owner, purchaser, or when designated by the owner, purchaser, or
consignee, an authorized agent acting on importer's behalf. The importer of record is the individual or firm liable for payment of all duties
and meeting all statutory and regulatory requirements incurred as a result of importation.
3. Name and Complete Address of Shipper. The name and address of person primarily responsible for exporting the pesticide to the
United States.
4. EPA Registration No. The pesticide product registration number assigned at the time of registration that identifies the product. The
product registration number must be an approved EPA Registration No. as it appears on the pesticide product label. If the pesticide does
not have an EPA registration number, it is recommended that “OTHER” be written in block 4 and block 18 be completed. If the product is a
device, write the word “DEVICE” in block 4.
5. EPA Producer Establishment No. The EPA Producer Establishment No. that appears on the pesticide or device product label. The EPA
Producer Establishment No. on the product label is the final establishment where the product was produced prior to shipment to the U.S.
Foreign establishments that produce pesticides or devices for distribution in the United States are required to have an EPA-registered
producer establishment number.
6. Brand Name of Product. Name of the product as it appears on the label at the time of import.
7. Active Ingredients and Percentage of Each. List each active ingredient by percentage of each. If block 4 contains an EPA Reg. No. or
the product is a device, this block may be left blank. To expedite review of the NOA, it is recommended that each active ingredient and
percentage be listed to ensure accuracy of information.
8. Unit Size. Net weight or net contents as identified on the product label of the pesticide or device in the immediate container, not
including the wrapper or other packaging materials.
9. Quantity. Number of units.
10. Total Net Weight. Unit size multiplied by quantity.
11. Country of Origin. The country of manufacture, production, or formulation of the pesticide or device of foreign origin entering the
United States.

EPA Form 3540-01 (Rev. 10/20) Previous versions are obsolete.

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12. Port of Entry. The port of entry where the pesticide or device offered for import is processed for entry into the United States. Ports of
entry are designated locations where CBP enforces the import and export laws and regulations of the United States federal government.
Ports of entry are under the jurisdiction of a CBP port director.
13. Name and Complete Address of the Carrier. The carrier is a person or carrier service (rail, ship, airline, trucking) who undertakes to
transport goods or merchandise to and across the U.S. border.
14. Entry Number. The 11-character entry number using the format XXX-NNNNNNN-N, including the hyphens.
15. Anticipated Entry Date. Anticipated date of entry into the United States or anticipated date when the pesticide or device will arrive
within the port of entry limits.
16. Confidential Business Information (CBI) designation. Please note that the information provided in blocks 4,5, 6, and 7 is not
entitled to confidential treatment under section 7(d) of FIFRA and under labeling requirements for pesticides at 40 CFR 156.10.
Information provided in those blocks will be made public with no further notice.
17. Location of Goods for Examination after Importation. Enter the physical address of the location of goods for examination after
importation. In the case of unregistered pesticides products imported between establishments operated by the same or different
producer(s), enter the EPA establishment number for the importing registered establishment.
18. Importation of Pesticides without an EPA Registration No. It is recommended that block 18 be completed for pesticides without
an EPA Registration No. Check all that apply and provide additional information as indicated. The Domestic Producer Establishment No. is
the EPA registered establishment where the imported product is transported to after release by Customs, if applicable.
19. Remarks. This block may be used to provide additional information. It is recommended that a copy of the label affixed to the product
be submitted with the NOA.
20. Printed Name of Importer of Record or Licensed Customs Broker. Print name and telephone number of the Importer of Record or
Licensed Customs Broker.
21. Signature of Importer of Record or Licensed Customs Broker. Signature of Importer of Record or Licensed Customs Broker.

EPA Regional Offices
EPA Region 1
5 Post Office Square
Suite #100 (OES 05-4)
Boston, MA 02109-3912
EPA Region 2
2890 Woodbridge Avenue
MS-500, Bldg #205
Edison, NJ 08837-3679
EPA Region 3
1650 Arch Street
PAPB/LCD (3LC32)
Philadelphia, PA 19103-2029

States and Ports of Entry
Locations in the U.S.

EPA Regional Offices

States and Ports of Entry
Locations in the U.S.

CT, MA, ME, NH, RI, VT

EPA Region 6
1445 Ross Avenue
Suite #1200 (6PD-P)
Dallas, TX 75202-2733

AR, LA, NM, OK, TX

NJ, NY, PR, VI

EPA Region 7
11201 Renner Boulevard
(WWPD/TOPE)
Lenexa, KS 66219-9601

IA, KS, MO, NE

EPA Region 8
1595 Wynkoop Street
Denver, CO 80202-1129

CO, MT, ND, SD, UT, WY

DE, DC, MD, PA, VA, WV

EPA Region 4
61 Forsyth Street, SW (APT-MD)
Atlanta, GA 30303-8960

AL, FL, GA, KY, MS, NC, SC, TN

EPA Region 5
77 West Jackson Boulevard.
(LC-8J)
Chicago, IL 60604-3507

IL, IN, OH, MI, MN, WI

EPA Form 3540-01 (Rev. 10/20) Previous versions are obsolete.

EPA Region 9
75 Hawthorne Street (CED-5)
San Francisco, CA 94105-3901
EPA Region 10
1200 Sixth Avenue
Suite 900 (OCE-084)
Seattle, WA 98101-3140

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AS, AZ, CA, GU, HI, MP, NV, Trust
Territories

AK, ID, OR, WA

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