Form DPR-REG-035 "Application to Amend Pesticide Product" - California

What Is Form DPR-REG-035?

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

Form Details:

  • Released on October 1, 2015;
  • The latest edition provided by the California Department of Pesticide Regulation;
  • 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 fillable version of Form DPR-REG-035 by clicking the link below or browse more documents and templates provided by the California Department of Pesticide Regulation.

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Download Form DPR-REG-035 "Application to Amend Pesticide Product" - California

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State of California
APPLICATION
DPR USE ONLY:
Department of Pesticide Regulation
TO AMEND
Application to Amend Pesticide
Tr. ID#
Product
PESTICIDE
Reg. No.
DPR-REG-035 (Rev. 10/15)
Page 1 of 2
R.S. Assigned
PRODUCT
Applicant Information
Important: Read all instructions before completing this form
1. Firm Name
2. Mailing Address of Firm
City
State
Zip Code
Check box if new address
City
State
Zip Code
3.
Street Address (if different from above) or
Agent Address
4. Name of Authorized Representative/Agent
5. Telephone Number of Representative/Agent
6. Fax Number
7. E-mail Address
8. Product Brand Name (exactly as shown on label)
9. U.S. EPA or CA Registration Number
10. Type of California amendment action requested (check all applicable)
Adding a crop
Compliance of U.S. EPA Pesticide Registration Notice
Adding a site or use
Reformatting and/or adding graphics (non-FIFRA related)
Adding a pest (i.e., weed, insect, bacteria, virus, fungi, etc.)
Other non-FIFRA related changes
Revise the signal word or the precautionary statements
Changes to warranty statement
Alternate formulation
Other (explain and attach cover letter)
Revised formulation
I certify, under penalty of perjury, that all information submitted on this application to amend pesticide product is accurate and complete.
As required by California Code of Regulations, Title 3 (3 CCR) §6170, all data that we submitted to the U.S. EPA to support this product
are enclosed in this submission or have previously been submitted to DPR.
/
/
X
Signature of Authorized Representative/Agent
Type or Print Name and Title
Date Signed
DPR USE ONLY:
Mail completed application to:
RC #
For correspondence only:
Department of Pesticide Regulation
Fee $
Pesticide Registration Branch
P.O. Box 4015
RC Date
Sacramento, California 95812-4015
Date Received
For package deliveries, FedEx, etc.:
OK by
Date Licensed
Department of Pesticide Regulation
Pesticide Registration Branch
Returned
1001 I Street
Sacramento, California 95814-2828
State of California
APPLICATION
DPR USE ONLY:
Department of Pesticide Regulation
TO AMEND
Application to Amend Pesticide
Tr. ID#
Product
PESTICIDE
Reg. No.
DPR-REG-035 (Rev. 10/15)
Page 1 of 2
R.S. Assigned
PRODUCT
Applicant Information
Important: Read all instructions before completing this form
1. Firm Name
2. Mailing Address of Firm
City
State
Zip Code
Check box if new address
City
State
Zip Code
3.
Street Address (if different from above) or
Agent Address
4. Name of Authorized Representative/Agent
5. Telephone Number of Representative/Agent
6. Fax Number
7. E-mail Address
8. Product Brand Name (exactly as shown on label)
9. U.S. EPA or CA Registration Number
10. Type of California amendment action requested (check all applicable)
Adding a crop
Compliance of U.S. EPA Pesticide Registration Notice
Adding a site or use
Reformatting and/or adding graphics (non-FIFRA related)
Adding a pest (i.e., weed, insect, bacteria, virus, fungi, etc.)
Other non-FIFRA related changes
Revise the signal word or the precautionary statements
Changes to warranty statement
Alternate formulation
Other (explain and attach cover letter)
Revised formulation
I certify, under penalty of perjury, that all information submitted on this application to amend pesticide product is accurate and complete.
As required by California Code of Regulations, Title 3 (3 CCR) §6170, all data that we submitted to the U.S. EPA to support this product
are enclosed in this submission or have previously been submitted to DPR.
/
/
X
Signature of Authorized Representative/Agent
Type or Print Name and Title
Date Signed
DPR USE ONLY:
Mail completed application to:
RC #
For correspondence only:
Department of Pesticide Regulation
Fee $
Pesticide Registration Branch
P.O. Box 4015
RC Date
Sacramento, California 95812-4015
Date Received
For package deliveries, FedEx, etc.:
OK by
Date Licensed
Department of Pesticide Regulation
Pesticide Registration Branch
Returned
1001 I Street
Sacramento, California 95814-2828
State of California
Department of Pesticide Regulation
Application to Amend Pesticide
Instructions for
Product
DPR-REG-035 (Rev. 10/15)
Application to Amend Pesticide Product
Page of 2
INCOMPLETE FORMS WILL NOT BE PROCESSED
If any section does not apply to your product, please mark it N/A. A separate application form must be completed for each product
brand name. If you require further assistance, contact the Pesticide Registration Branch at 916-445-4400.
1.
Firm Name: If federally registered, this must be the same as on file with U.S. EPA. For California registered products that do not
require federal registration, this must match what is currently on file with DPR.
2.
Firm Mailing Address: Correspondence, licenses, notices, etc. will be sent to this address.
4.
Name of Authorized Representative: The person who is authorized to answer questions about your application. Generally, this
person prepares the application. If the person is an agent, a letter from the firm authorizing the agent to act on their behalf is
required.
7.
E-mail address: Supplying DPR with this information will automatically enroll the applicant (firm or agent) into the automatic
notification program.
8.
Product Brand Name: This must be EXACTLY the same as the brand name registered by U.S. EPA and the product labeling.
For California registered products that do not require federal registration, this must match what is currently on file with DPR.
9.
U.S. EPA or CA Registration Number: Required unless the product is exempt from, or does not require, registration under the
Federal Insecticide Fungicide and Rodenticide Act (FIFRA) such as spray adjuvants, FIFRA §25(b) exempt pesticides, or the
product is being submitted concurrent with submission to U.S. EPA under the DPR’s current policy. For California registered
products that do not require federal registration, the CA Reg. No. is required.
10. Type of California Amendment Action Requested:
• Adding sites or uses, crop, pests, or reducing the signal word or the precautionary statements: In your cover letter,
please specify changes (e.g., list added use or pest), data and/or reference to data or similar products to support the changes.
• Alternate and Revised Formulations: Include a copy of the U.S. EPA acceptance letter of the alternate or revised formulation.
For California registrations (i.e., spray adjuvants), complete a Product Formulation Information Form.
• Non-FIFRA related changes: Reformatting and/or adding graphics, Warranty Statement changes, etc.
• Other: Please attach a cover letter explaining the type of amendment action requested.
The Application Package shall include the following:
A cover letter describing the type of amendment action
U.S. EPA Notification Submission (EPA Form 8570-1) to
requested and what is being submitted to DPR
support other label changes not addressed by the U.S. EPA
stamped-accepted label, if applicable
A completed application form (electronic signatures are not
accepted). If submitting an alternate or revised formula, submit
One copy of the data required by California regulations
a copy of the U.S. EPA Confidential Statement of Formula or
(Title 3, California Code of Regulations §6170) and formatted
complete a Product Formulation Information Form. For a
according to DPR’s current policy
California only registration (e.g., spray adjuvant), complete a
In lieu of submitting data, you may include in your cover letter
Product Formulation Information Form
a reference to specific data on file with DPR or identification of
An application fee of $25 is required. Make check or money
a pesticide product(s) previously approved by the Director that
order payable to “Cashier, Department of Pesticide Regulation”
would be subject to some or all of the same data requirements
as applicable to the applicant’s product. NOTE: Pursuant to
Six (6) copies of the product labeling; typescript labeling
California Food and Agricultural Code §12811.5, applicant’s relying
may be submitted if printed labels are not yet available; printer's
upon data owned by another company may, have certain
proofs or final printed labels are required prior to an acceptance
obligations to the data owner in specifically defined situations. For
of the amendment
further information, please refer to
<http://www.cdpr.ca.gov/docs/legbills/ab1011/resource.htm>
Copy of U.S. EPA stamped accepted label, and acceptance
letter, if applicable
Information Available on the Internet
Information about the California laws and regulations governing pesticide registration, as well as Department notices, policies, and
procedures is available on the Internet at <http://www.cdpr.ca.gov>. Information on currently registered products, registrants,
telephone numbers, and e-mail addresses for Department staff, and other information are also available at this site.
“A Guide for Pesticide Registrants” is also available online. This Guide includes information regarding the overall process of registering
pesticides and information regarding how to maintain registration in California. Checklists for preparing your application package for
New Products, Alternate (or Additional) Brand names, Subregistrations, and Label or Formulation Amendments are available online.
Persons interested in receiving notices specific to registration issues must subscribe to the e-mail list or access the “California Notices
to Registrants” web page found on the Departments’ Web site. To subscribe to “California Notices to Registrants” for email delivery,
visit the E-List page at <http://www.cdpr.ca.gov/docs/listserv/listdesc.htm>, and click on the subscribe link under the list name. You will
receive an e-mail, welcoming you to the list. To access new and historical notices via the Internet, see
<http://www.cdpr.ca.gov/docs/canot/camenu.htm>.
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