Form DP-21 "Application for Registration of Pesticides" - Arkansas

What Is Form DP-21?

This is a legal form that was released by the Arkansas Agriculture Department - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Arkansas Agriculture Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DP-21 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

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Download Form DP-21 "Application for Registration of Pesticides" - Arkansas

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Form DP-21 (Rev. 9/20)
ARKANSAS
APPLICATION FOR REGISTRATION OF PESTICIDES
This registration is for the calendar year ending December 31,
Refer to back of page for instructions. Do not write in shaded areas of form.
Product
EXEMPT
EPA
ID
Complete Brand Name of Pesticide
APD Fee
Registration
Number
(Y or N)
Number
Category
Total # of Products: ___________________
Total Fee Enclosed $
Company Name
I hereby certify that the above
representations and attachments are
Mailing Address
true and correct.
City
State
Zip
Date
DO NOT write in this space
Signed
____________________________
Approved
Printed Name
Pesticide Section
Telephone
Date _________________________________
Email
Check to Receive Certificate by Email
***This DP-21 form is for mail-in application with payment by check only. To Register
and Pay Online for a New Pesticide Registration, visit the Pesticide Section webpage:
https://www.agriculture.arkansas.gov/plant-industries/pesticide-section/forms/
Form DP-21 (Rev. 9/20)
ARKANSAS
APPLICATION FOR REGISTRATION OF PESTICIDES
This registration is for the calendar year ending December 31,
Refer to back of page for instructions. Do not write in shaded areas of form.
Product
EXEMPT
EPA
ID
Complete Brand Name of Pesticide
APD Fee
Registration
Number
(Y or N)
Number
Category
Total # of Products: ___________________
Total Fee Enclosed $
Company Name
I hereby certify that the above
representations and attachments are
Mailing Address
true and correct.
City
State
Zip
Date
DO NOT write in this space
Signed
____________________________
Approved
Printed Name
Pesticide Section
Telephone
Date _________________________________
Email
Check to Receive Certificate by Email
***This DP-21 form is for mail-in application with payment by check only. To Register
and Pay Online for a New Pesticide Registration, visit the Pesticide Section webpage:
https://www.agriculture.arkansas.gov/plant-industries/pesticide-section/forms/
Form DP-21 (Rev. 9/20)
Instructions for the Arkansas Application for Registration of Pesticides (DP-21 (Rev. 10/19)) form
This form is for Registration of products that are not listed on the DP-21 Renewal:
1.
Indicate calendar year ending December 31.
AProduct ID Number@ column: Do Not Write In This Space!
2.
AComplete Brand and Name of Pesticide@ column: Indicate complete Brand and name of pesticide.
3.
Registrants desiring to discontinue a product registration should be aware that Arkansas requires a two-year discontinuance. A
“Out of the Channels of Trade” letter stating there is no product within the channels of trade in lieu of the discontinuance period is
acceptable. 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.
AAPD Fee Exempt@ column: Please indicate AY@ if a product is exempt from paying the APD fee or AN@ if a product is not exempt
4.
and is required to pay the APD fee.
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. 9/20)) 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.
AEPA Registration Number@ column:
5.
Indicate complete EPA Registration Number
ACategory@ column: Do Not Write In This Space!
6.
ATotal Fee enclosed@: Please indicate the total amount of fees.
7.
$ 250.00 Registration Fee per product
$ 50.00 APD Fee per product, if not exempt
ACompany Name, mailing address, City and State, Signature, Printed Name, Date of Application, Telephone Number and
8.
Email @:
Please complete for each field accordingly.
9.
“Check to Receive Certificate by Email”: To receive electronic correspondences please check the box. Registration
documents will be emailed in lieu of a mailed hard copy.
Submit the completed DP-21 (Rev. 9/20) to the PLANT INDUSTRIES, PESTICIDE SECTION, 1 NATURAL RESOURCES
DRIVE, LITTLE ROCK, AR 72205 with the following required documentation:
-
Check payable to State Plant Board for the total amount of fees
-
PDF format of
a complete product label.
Labels may
be submitted
on
a CD,
emailed
to
Pesticide.registration@arkansas.gov
or uploaded to Accepted Labels State Tracking and Repository (ALSTAR)
database.
-
Out of channels of trade letter if applicable.
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