Form 009-0400 "Application for Registration of Pesticides in Iowa" - Iowa

What Is Form 009-0400?

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

Form Details:

  • Released on December 1, 2014;
  • The latest edition provided by the Iowa Department of Agriculture and Land Stewardship;
  • 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 009-0400 by clicking the link below or browse more documents and templates provided by the Iowa Department of Agriculture and Land Stewardship.

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Download Form 009-0400 "Application for Registration of Pesticides in Iowa" - Iowa

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(Print setup: Landscape/Duplex)
APPLICATION FOR REGISTRATION OF PESTICIDES IN IOWA
Iowa Department of Agriculture and Land Stewardship
Registration fee for new products: $250.00 each
Pesticide Bureau—Attn: Product Registrations
th
Specific information and instructions are on the reverse side of this page.
Wallace State Office Building -- 502 E. 9
Street
Des Moines, IA 50319
Application is hereby made for the registration of the following pesticide products through
Phone: 515-281-8591 FAX: 515-242-6497
December 31, __________(year). Remittance, payable to the Iowa Department of Agriculture and
Http://www.iowaagriculture.gov/pesticides.asp
Land Stewardship (IDALS), is enclosed to cover the annual registration fee(s).
Registration submitted BY
: (product renewals & receipts will go to this address)
EPA-Assigned Company Number or Iowa Agent ID:
Company/Firm
Is this a change of address or agent
Division of
?
Yes
No
Contact person & title
Signature & Date
Mailing address
City
Country (if not USA)
State/Province
ZipCode+4 or Postal Code
Primary phone w/area code
Alternate phone w/area code
FAX w/area code
Contact e-mail address
Company web site
Registration(s) submitted FOR:
Same as above
EPA-Assigned Company Number:
Submitted for Firm:
City, State, Zip
EPA Reg. No.
Brand — Trade name — Grade
RUP*
Type*
ALSTAR*
Fee
Penalty*
Total
IDALS USE ONLY
No
No
$250
$
$
Yes
Yes
No
No
$250
$
$
Yes
Yes
No
No
$250
$
$
Yes
Yes
No
No
$250
$
$
Yes
Yes
Page Total:
0.00
Your Check Number: _____________
$
Page _____ of ______ page(s)
*See instructions reverse side of this form.
IDALS USE ONLY
P
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Val Code #65
Form No. 009-0400 rev 12-2014
\SANDBE\DATAPROC\REGIS\FRMRegistrationApplicationRev12-2014.pdf
(Print setup: Landscape/Duplex)
APPLICATION FOR REGISTRATION OF PESTICIDES IN IOWA
Iowa Department of Agriculture and Land Stewardship
Registration fee for new products: $250.00 each
Pesticide Bureau—Attn: Product Registrations
th
Specific information and instructions are on the reverse side of this page.
Wallace State Office Building -- 502 E. 9
Street
Des Moines, IA 50319
Application is hereby made for the registration of the following pesticide products through
Phone: 515-281-8591 FAX: 515-242-6497
December 31, __________(year). Remittance, payable to the Iowa Department of Agriculture and
Http://www.iowaagriculture.gov/pesticides.asp
Land Stewardship (IDALS), is enclosed to cover the annual registration fee(s).
Registration submitted BY
: (product renewals & receipts will go to this address)
EPA-Assigned Company Number or Iowa Agent ID:
Company/Firm
Is this a change of address or agent
Division of
?
Yes
No
Contact person & title
Signature & Date
Mailing address
City
Country (if not USA)
State/Province
ZipCode+4 or Postal Code
Primary phone w/area code
Alternate phone w/area code
FAX w/area code
Contact e-mail address
Company web site
Registration(s) submitted FOR:
Same as above
EPA-Assigned Company Number:
Submitted for Firm:
City, State, Zip
EPA Reg. No.
Brand — Trade name — Grade
RUP*
Type*
ALSTAR*
Fee
Penalty*
Total
IDALS USE ONLY
No
No
$250
$
$
Yes
Yes
No
No
$250
$
$
Yes
Yes
No
No
$250
$
$
Yes
Yes
No
No
$250
$
$
Yes
Yes
Page Total:
0.00
Your Check Number: _____________
$
Page _____ of ______ page(s)
*See instructions reverse side of this form.
IDALS USE ONLY
P
P
D
:
P
E
F
#
B
#
$
ROD
ROC
ATE
AYMENT
NTERED
ORM
ATCH
P
:
H
:
R
:
R
D
:
S
#
S
B
#
ROCESSED
ELD
EPROCESSED
EPROC
ATE
UB FORM
UB
ATCH
Val Code #65
Form No. 009-0400 rev 12-2014
\SANDBE\DATAPROC\REGIS\FRMRegistrationApplicationRev12-2014.pdf
INSTRUCTIONS:
This form is for the registration of new pesticide products only.
If you need to renew previously-registered
products please contact the Pesticide Bureau to request a renewal package. Phone 515-281-8591 or pesticides@iowaAgriculture.gov
ALSTAR:
“No” if this company is not an
SUBMIT YOUR APPLICATION TO IDALS:
Application for registration: Submit original
ALSTAR participant. DO NOT submit labels
only. A confirmation of registration will be
Review the check list below to ensure
via CD.
provided by return mail.
completeness of your application:
“Yes” if the new product label is being
Registration submitted BY: Enter the
submitted via ALSTAR and provide ALSTAR
All information is completed on the
requested information for the company or
Company Label ID below the product name..
application form.
agent responsible for the registration of
Application is signed and dated.
pesticide products. Receipts and renewal
(for more information about the ALSTAR system, please go to
Fees are correctly calculated
http://ppis.ceris.purdue.edu/alstar.htm )
forms will be directed to this address. If you
Check in the correct amount made payable to
are a new agent, a letter of authorization from
FEE: All new product registrations are subject to
IDALS.
the registrant also needs to be included.
the minimum $250 registration fee per
Check number written in space provided on
product. All registrations expire December 31
Registration submitted FOR: Enter the name
the application form
of the year registered.
of the company, distributor or subsidiary for
One LEGIBLE copy of complete final product
PENALTY: A penalty of 25% of the registration
which registration is being applied for. If this
labeling provided in printed form — do not
fee due ($62.50 for new products) if the
information is the same as the ‘submitted by’
submit labels on CD. Do not send EPA-
product has been found in the channels of
information, please check the box, “Same as
approved master labels unless specifically
trade without being registered by IDALS.
above.”
requested by IDALS.
(Exception: discontinued pesticides as described
in Iowa Administrative Code 21-45.3.)
For ALSTAR Participants: Please ensure you
IDALS use only: Leave these areas blank.
have completed the following:
TOTAL: Add the registration fee and penalty
EPA Reg. No. Enter the product EPA
uploaded the new product label to
due (if any) and enter in this column.
Registration Number for the product.
ALSTAR for Iowa
checked “Yes” in the ALSTAR column of
Brand/Trade name/Grade: List the complete
the application form
brand name, trade name, and if applicable,
YOUR CHECK NUMBER AND FORM TOTAL
Provided the ALSTAR Company Label ID
grade of the pesticide product as shown on
AMOUNT ENCLOSED: To aid in processing,
on the application form
the final printed labeling.
please note your check number and total
amount submitted.
RUP:
“Yes” if the product is classified as a
Send completed application form, payment
“Restricted Use Pesticide.”
“No” if the
(payable to “IDALS”) and supporting
REGISTRATION RENEWALS: Registrations
product is not classified as an RUP.
documentation to:
must be renewed each calendar year. IDALS
TYPE: Enter the appropriate code for each
IDALS—Pesticide Bureau
mails renewal forms each November to the entity
product from the following list:
Attention: Product Registrations
on record for handling Iowa pesticide product
Henry A. Wallace Building—502 East 9th St.
registration issues for a registrant. The annual
Type Code Description
Des Moines, IA 50319-0051
renewal fee is based on one-fifth of one percent
Incomplete applications will be returned
(0.002) of the gross sales of each product
01
FIFRA Section 3
without processing.
distributed in the state of Iowa for the previous
02
Special Local Need /24(c)
calendar year with a minimum fee of $250 per
product and a maximum of $3,000 per product.
The State of Iowa reserves the right to
Section 18
03
approve, accept, disapprove or reject any
Iowa requires a two-year discontinuance period
04
EUP-Experimental Use
registration for a reasonable period of time
before product registrations are eligible for
and attaches no legal rights or obligations to
05
Exempt from Section 3 FIFRA
cancellation by the registrant or authorized
the immediate processing of your remittance.
registration such as FIFRA 25(b)
agent.
Minimum Risk Pesticides
Web site — http://www.iowaagriculture.gov/pesticides.asp
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