Form 8500-25 Accreditation Application For Training Programs

United States
Environmental Protection
Agency

Office of Prevention,
Pesticides, and
Toxic Substances

EPA 747-B-98-003
September 2004
http://www.epa.gov/lead

Application and
Instructions for
Training Providers
Applying for Accreditation of LeadBased Paint Activity Training
Programs

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Form Approved OMB No. 2070-0155 Expires 02/29/08

Clear data

ACCREDITATION APPLICATION

U. S. ENVIRONMENTAL PROTECTION AGENCY

FOR TRAINING PROGRAMS

Important: Consult the instructions provided for training programs applying for accreditation of lead-based paint activities
courses to complete this form. Please type or print responses in black or blue ink only.
Official Use Only

A. General Information
Select one of the following application types:

‘
‘
‘
‘

Initial accreditation application
Re-accreditation application
Adding jurisdiction(s) to accreditation/amending accreditation
Replacement of a certificate

For information on EPA and
other lead programs, see:
http://www.epa.gov/lead

Indicate the course(s) for which you seek accreditation or re-accreditation. List
all EPA-run jurisdiction(s) in which you intend to conduct lead-based paint
activity training. An EPA-run jurisdiction includes an EPA-run state, U.S.
territory, or all Indian tribal land(s) in any one EPA Region. Attach additional
sheets of paper, as necessary.

‘ Check here to be listed on
EPA’s web site

The fee you must pay depends on the number of disciplines and EPA-run jurisdiction(s) in which you plan to conduct leadbased paint activity training. See the fees schedule in the instructions to determine your fee. The total fee listed below
should include fees calculated on any additional sheets.
Inspector
I = Initial

R = Refresher

I

Supervisor

R

I

R

Risk
Assessor
I

R

Project
Designer
I

R

Abatement
Worker
I

Fee

R

‘ ‘

‘ ‘

‘ ‘

‘ ‘

‘ ‘

$_________

‘ ‘

‘ ‘

‘ ‘

‘ ‘

‘ ‘

$_________

(List on additional sheets of paper and attach, as necessary. Each additional jurisdiction $35 per discipline, per jurisdiction.)
*See the definition of EPA-run jurisdiction(s) and the fee examples in the instructions. For current listing

of EPA-run jurisdictions, see www.epa.gov/lead or call 1-800-424-LEAD.

$_________

______________________________
1st EPA-run jurisdiction* (pay base accreditation fee only)
______________________________
2nd EPA-run jurisdiction*

‘

Check here if you are listing additional EPA-run jurisdiction(s)

Worker courses in a language other than English (list each language separately): __________
(Note: Only worker course(s) can be taught in a language other than English. $1,760 for initial course, $1,010

for refresher course, and $35 for each additional EPA-run jurisdiction per language.)
Do you request a fee waiver as a:

‘

Local government applicant

‘

‘ ‘

$_________

0.00
Total Fee: $_________

State government applicant

‘ Nonprofit applicant: (Nonprofit means an entity that has demonstrated to any branch of the
Federal Government or to a state, municipal, tribal, or territorial government, that no part of its
net earnings inure to the benefit of any private shareholder or individual.)

If your training program designation is nonprofit, specify the IRS-issued number below and submit a copy of an official IRS
letter confirming such designation. If another agency/state has designated your nonprofit status, indicate the agency/state
and corresponding identification number and attach appropriate documentation.

‘ 501(c)(3) ___________
IRS-issued number

‘ 501(c)(5) ___________
IRS-issued number

‘ 501(c)(9) ____________ ‘ Other ___________________
IRS-issued number

B. Applicant Information
Name of Training Program and Street Address: _________________________________________________________
Business, State, Agency, etc.

-

_____________________________________________________________________________________________________________________________________________________________
Street Address, Suite Number (Please no P.O. Box)
City
State
Zip Code

Mailing Address:__________________________________________________________________________________
Address

City

State

Zip Code

Applicant’s Phone #: (_____) ____-_______ ext. ______Applicant’s Fax #: (_____) _____-_______
Applicant’s E-mail Address:_________________________________________________________________________

EPA Form 8500-25 (Rev 09/04)

Page 1 of 4

ACCREDITATION APPLICATION FOR TRAINING PROGRAMS (CONTINUED)

Form Approved OMB No. 2070-0155 Expires 02/29/08

Please list all types of facilities and locations at which training will take place. Attach additional sheets of paper, as
necessary.

__________________________________________________________________________________________________
Type of Facility

Street Address, Suite Number (Please no P.O. Box)

City

State

Zip Code

__________________________________________________________________________________________________
Type of Facility

Street Address, Suite Number (Please no P.O. Box)

City

State

Zip Code

C. Qualifications of Training Program Manager
Name of Training Program Manager: ____________________________________________________________________
Last

First

Middle

Training Program Manager’s Title: __________________________________________________________________
Previous and/or Maiden Name(s), if applicable: _________________________________________________________
Teaching Workers or Adults Requirement of §745.225(c)(1)(i), (ii), or (iii):
Check one of the following:

‘ Experience

or

‘ Education

or

‘ Training

or
‘ Bachelors
or graduate degree
in any field

‘ Experience managing a
or
training program specializing in
environmental hazards

Circle the supporting documentation attached for the box checked above:
Experience
Resume
Letter of Reference
Documentation of
Work Experience

Education
Diploma
Transcript

Training
Diploma
Transcript
Certificate

Bachelors
Diploma
Transcript

Management experience
Resume
Letter of Reference
Documentation of
Work Experience

Construction Industry Requirement of §745.225(c)(1)(iv):
Check one of the following:

‘

Experience

or

‘

Education

or

‘

Training

Circle the supporting documentation attached for the box checked above:
Experience
Resume
Letter of Reference
Documentation of Work Experience

Education
Diploma
Transcript

Training
Diploma
Transcript
Certificate

D. Qualifications of Principal Course Instructor (Attach a separate sheet for each individual.)
Name of Principal Course Instructor for each course: ____________________________________________________
(If more than one, attach additional sheets.)

Last

First

Middle

Previous and/or Maiden Name(s), if applicable: ________________________________________________________
Teaching Workers or Adults Requirement of §745.225(c)(2)(i):
Check one of the following:

‘

Experience

or

‘

Education

or

‘

Training

Circle the supporting documentation attached for the box checked above:
Experience
Resume
Letter of Reference
Documentation of Work Experience

EPA Form 8500-25 (Rev 09/04)

Education
Diploma
Transcript

Training
Diploma
Transcript
Certificate

Page 2 of 4

ACCREDITATION APPLICATION FOR TRAINING PROGRAMS (CONTINUED)

Form Approved OMB No. 2070-0155 Expires 02/29/08

Completion of Accredited Lead-specific Training Requirement of §745.225(c)(2)(ii):
Check as many that apply and complete information for each. Attach additional sheets of paper, as necessary.

Discipline: ‘ Inspector

‘ Supervisor

‘ Risk Assessor

‘ Project Designer

‘ Abatement Worker

Specify EPA or name of accrediting EPA-authorized state, U.S. territory, or Indian tribe:_______________________

Name of Trainer:_______________________________

Name of Training Program:_______________________

Training Program Address: ______________________________________________________________________

Street Address, Suite Number

City

Training Program Phone #:(_____) _____-_______ ext. _____

State

Zip Code

Date Training Completed: _________________
Month/Day/Year

Training Certificate Identification Number: ______________________
Construction Industry Requirement of §745.225(c)(2)(iii):
Check one of the following:

‘

Experience

or

‘

Education

or

‘

Training

Circle the supporting documentation attached for the box checked above:
Experience

Resume

Letter of Reference

Documentation of Work Experience

Education
Diploma
Transcript

Training
Diploma
Transcript
Certificate

E. Lead-Based Paint Activity Violations
Does the training program have any past, present, or pending lead-based paint activity
violations of EPA, state, U.S. territory, or Indian tribal land(s) regulations?

‘ Yes

‘ No

If yes, please attach a written explanation.
F. Certification of Course Training Material
I certify that I am using the course training materials as marked in the boxes below for each of the courses that I am seeking
accreditation as required by §745.225(b)(1)(iii). My signature in Section I applies to this Section F.
Inspector

Supervisor

Risk
Assessor

Project
Designer

Abatement
Worker

EPA recommended training materials

‘

‘

‘

‘

‘

Authorized state course/program (attach documentation that course
and/or program is state-approved)

‘

‘

‘

‘

‘

Other LBP training (contact the Help Line at 1-800-424-LEAD)

‘

‘

‘

‘

‘

G. Re-accreditation Applicants Only
Use the following space to describe any changes to the training facility, equipment, or course materials since the training
program’s last application was approved. Attach additional sheets of paper, as necessary.
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

H. Additional Information
Use the following space for any additional information or comments that you feel are relevant and want EPA to consider
with your application. Attach additional sheets of paper, as necessary.
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

EPA Form 8500-25 (Rev 09/04)

Page 3 of 4

ACCREDITATION APPLICATION FOR TRAINING PROGRAMS (CONTINUED)

I.

Form Approved OMB No. 2070-0155 Expires 02/29/08

Certification Statement

Privacy Act Statement: This statement is provided pursuant to the Privacy Act of 1974, 5 U.S.C. §552a. The authority for collecting this information is 40 C.F.R. Part 745, and 15 U.S.C.
§§2682 and 2684. The information collected on this form will be used to establish the applicant’s eligibility to receive accreditation to conduct training in the field of lead-based paint activities
in target housing and child-occupied facilities. Disclosure of this information is voluntary, however, the failure to provide this information may delay or prevent an applicant’s accreditation.
This information may be disclosed in appropriate and limited circumstances to: EPA employees, contractors, grantees or others when performing duties that are compatible with the purpose
for which this information is collected and when this information is necessary to complete the task; a member of Congress in response to a request made with your consent and on your
behalf; to appropriate law enforcement agencies responsible for investigating, enforcing, prosecuting or implementing specific statutes, codes or regulations and this information is relevant
to that responsibility; an appropriate adjudicative body when such disclosure is compatible with the purpose for which this information is collected and the EPA or the United States has
an interest in the proceeding; and the Department of the Treasury, the General Services Administration, the General Accounting Office and other Federal, State, and Local Agencies for
authorized activities related to this information.

I certify that the lead-based paint activity training program described in Parts A through H of this application, including any attachments,
meets the requirements established in paragraph (c) of 40 CFR § 745.225. I hereby attest and affirm that the information included on
this application, including any attachments, is true and accurate to the best of my belief and knowledge. I acknowledge that any
accreditation issued pursuant to this application, including any attachments, will be subject to revocation if issuance was based on
incorrect or inadequate information that materially affected the decision to issue the accreditation. I also attest and affirm that I will
maintain my accreditation(s) according to 40 CFR § 745.225 and conduct lead-based paint activities training only in those disciplines
and geographical areas in which I have received accreditation.
A false statement on this form may lead to prosecution under 18 U.S.C. 1001 or to imposition of applicable criminal and civil penalties
and/or administrative remedies.

________________________
Date Signed
Training Program Manager’s Signature

(Please sign legibly within the boundaries of the box above.)

Before you mail your application and accreditation fee, make sure that you have:
Filled out all applicable sections of the application

Signed and dated the application

Made a copy of your application for your files

Enclosed education, experience, and other documentation for

the Training Program Manager and Principal Course Instructor

Enclosed a description of facilities and equipment

Enclosed the course test blueprint

Enclosed a description of activities and procedures for hands-

on skills assessment

Enclosed quality control plan(s)

Enclosed course manual(s) and course agenda(s) (if not using

EPA recommended or authorized State or Indian tribe approved

training materials)

Enclosed the appropriate accreditation fee(s) (check or money

order)

Printed “Lead Program User Fees” on the check or money order
For more information, see the fees section in the instructions
Mail original completed application, supporting materials,

and accreditation fee to:

U.S. EPA
Lead User Fees

P.O. Box 979072
St. Louis, MO 63197-9000

EPA Form 8500-25 (Rev 09/04)

Page 4 of 4

INSTRUCTIONS FOR TRAINING PROGRAMS APPLYING FOR

ACCREDITATION OF LEAD-BASED PAINT ACTIVITIES COURSES

You may apply to the U.S. Environmental Protection Agency (EPA) for accreditation or reaccreditation of a lead-based paint activities initial course(s) and/or refresher course(s) in any of
the following disciplines: Inspector, Supervisor, Risk Assessor, Project Designer, or
Abatement Worker in states, U.S. territories, and all Indian tribal land(s) in any one EPA
Region where EPA implements the lead-based paint accreditation program. If EPA does not
administer the accreditation program in an area where you wish to offer training, you must apply
directly to that state, territory, or Indian tribe for accreditation.
These instructions supplement EPA form 8500-25 (Rev 09/04), Accreditation Application For
Training Programs. Please note that you must use a separate application form for each
application type. For example, if you are applying for initial and re-accreditation in two
disciplines, you must use two separate application forms.
How to Apply for Initial Accreditation
To apply for accreditation of a training program(s), you must:
•
•
•
•

•

•

•

Complete, sign, and date EPA form 8500-25 (Rev 09/04).
Calculate the appropriate fee using the fees schedule provided with these instructions.
Provide education, experience, and other documents for the Training Program Manager
and Principal Course Instructor.
Enclose the following materials with your application:
<
Description of training facilities and hands-on training equipment;
<
Course test blueprint;
<
Description of activities and procedures for conducting the hands-on skills
assessment; and

<
Quality control plan(s), described in 40 CFR §745.225(c)(9).

Indicate whose course materials you will use:
<
EPA-recommended;
<
EPA-authorized state or Indian tribe approved (for all course materials that are
approved by an EPA-authorized state or Indian tribe, you must also enclose a
copy of the authorized program approval of the course); or
<
Your own (for all course materials that are your own, that is, are not EPArecommended or approved by an EPA-authorized state or Indian tribe, you must
also enclose a complete course packet, including an agenda, student and
instructor manuals, course tests, and other materials).
Submit a complete course packet for each discipline. If a document is used in multiple
courses, a copy of the document must be included in each course packet. Submitting
incomplete sets of course materials will delay the review of all materials submitted for
accreditation.
Print “Lead Program User Fees” on the check or money order for the fee and mail it with
your application to the following address:
U.S. EPA
Lead User Fees

P.O. Box 979072
St. Louis, MO 63197-9000

How to Apply for Re-accreditation
All training course accreditations expire every four (4) years. To ensure that your training
program will be re-accredited before your current accreditation expires, you must submit your
re-accreditation application no later than 180 days before the expiration date.
For re-accreditation, complete only sections A (General Information), B (Applicant Information),
F (Re-Accreditation Applicants Only), and H (Certification Statement) of the application and
follow the mailing instructions described in the “initial accreditation” section of these instructions.
Amended Application
Amended applications must be sent to the following address:
U.S. EPA
P.O. Box 14417
Washington, DC 20044-4417

Replacement of a Certificate
To replace a certificate, complete only sections A (General Information), B (Applicant
Information), and H (Certification Statement) of the application and follow the mailing
instructions described in the “initial accreditation” section of these instructions.
Incomplete Application
If your application is incomplete, EPA will not process your application. If any components of
your application are missing, your application will become inactive for a period not to exceed 30
days until the application is made complete. If you do not complete your application, EPA will
return the application package. You may apply again with a complete package. Please call 1800-424-LEAD to see if your application is complete.
Fees
The fee for applying for accreditation, re-accreditation, and other requests is listed in the
following schedule. It is important that you:
•
•

•
•

Calculate the fee based on the number of discipline(s) and EPA-run jurisdiction(s) in
which you plan to operate.
Submit one $35 fee for all Indian tribal land(s) in any one EPA Region, if applying for
accreditation in multiple Indian tribal lands, and list each tribe by name and include their
address(es).
Write your total fee amount in section A of the application, even if you attach additional
sheets of paper listing additional EPA-run jurisdictions.
Make the check or money order payable to U.S. Environmental Protection Agency.
Other methods of payment include wire transfer, electronic funds transfer, and, for
government payers only, on-line payment agency collection (OPAC).

Fees Schedule
Course

Accreditation Fee

Re-accreditation Fee
[every 4 years, see 40 CFR 745.225(f)(1)]

Initial Course
Inspector

$2,500

$1,600

Supervisor

$3,250

$2,050

Risk Assessor

$1,760

$1,150

Project Designer

$1,010

$710

Abatement Worker in English

$1,760

$1,150

In language other than English*

$1,760

$1,150

$1,010

$710

Supervisor

$1,010

$710

Risk Assessor

$1,010

$710

$640

$490

Refresher Course
Inspector

Project Designer
Abatement Worker in English

$1,010

$710

In language other than English*

$1,010

$710

Multi-jurisdictional Accreditation Fee**

$35 per discipline for each additional EPA-run jurisdiction***

Replacement Certificate

$15

*Applies to Abatement Worker courses only.

**Multi-jurisdictional accreditation applies to an applicant applying in more than one EPA-run jurisdiction.

***An EPA-run jurisdiction includes an EPA-run state, a U.S. territory, or all Indian tribal land(s) in any one EPA Region. (For current listing of EPA-run jurisdictions, see

www.epa.gov/lead or call 1-800-424-LEAD.)

Fee Examples
1)

If training program is applying for initial Worker course accreditation in two states:
Initial Worker accreditation fee
One additional state fee*
Total Amount Due:

2)

If training program is applying for initial Worker Spanish and initial Worker Polish
courses accreditation in two states:
Initial Worker Spanish accreditation fee
Initial Worker Polish accreditation fee
One additional state fee* (2 disciplines)
Total Amount Due:

3)

$ 1760
$ 35
$ 1795

$ 1760
$ 1760
$ 70
$ 3590

If training program is applying for refresher Worker course accreditation in two states
and all Indian tribes in one EPA Region:
Refresher Worker accreditation fee

One additional state fee*

All Indian tribes in one EPA Region fee*

Total Amount Due:

*Each accreditation request includes the fee for one EPA-run jurisdiction.

$ 1010
$ 35
$ 35
$ 1080

EPA’s Accreditation Fees Refund Policy
Training programs having submitted an application and associated fees for accreditation or reaccreditation who wish to withdraw their application prior to Agency approval will receive a fee
refund based upon the schedule listed below. Training programs who request a refund
more than 10 days after the Agency receives the application will not receive a 100
percent refund.
Number of Days Following Agency Receipt of
Application

Percent Reimbursable (based upon total fees
submitted for a particular discipline)

up to 10 days

100%

11 to 60 days

75%

61 to 120 days

50%

121 or more days

25%

Note: Refunds will only be made after EPA verifies fee receipt and deposit by the U.S.
Treasury.
Training programs must notify the Agency in writing in order to qualify for a refund. The date of
withdrawal is the date on which the Agency received the withdrawal notification.
EPA will not refund fees after granting a training program accreditation or re-accreditation.
Refunds are granted only on a per discipline basis. Therefore, training programs must withdraw
their application for a particular discipline in all EPA-run jurisdiction(s) included on the
application. If your application is disapproved, EPA will not refund fees.
Refunds are not available for replacing a certificate.

Application Process for Training Program Accreditation
EPA processes applications on a first-come, first-served basis. The flowchart below depicts the
application process for training program accreditation. EPA has up to 180 days after receiving a
complete request for accreditation to approve or disapprove the application.
Training program submits application
and fee to EPA

Is the
application
complete?

Training program
submits m issing
information

No

EPA sends letter
deta iling missing
information

Yes

EPA sends the training
program a letter indicating that
the application is complete

Is the training
program qualified
for accreditation?
Yes

No

EPA works with
training program to
improve application

If application is insufficient, EPA
sends a discrepancy letter
detailing areas for improvement

EPA sends
approval letter and
certificate
Training provider responds to
the discrepancy letter and EPA
continues its review of the
application

EPA approves the application
or continues to work with the
applicant until the application is
approved or withdrawn

Training program may
reapply at any time

Paperwork Reduction Act Notice: The annual public burden for this collection of information is estimated to be 27.6 hours per
accreditation response, and 4.8 hours per re-accreditation response, including the time needed for reading the instructions and
completing the necessary information contained in this form. Send comments regarding the burden estimate or any other aspect
of this collection of information, including suggestions for reducing the burden to: Director, Collection Strategies Division,
Office of Environmental Information (OEI), U.S. Environmental Protection Agency (Mail Code 2822), 1200 Pennsylvania
Avenue, N.W., Washington, D.C. 20460. Include OMB No. 2070-0155 in any correspondence. Do not send the completed form
or requested information to this address. The actual information or form should be submitted in accordance with the instructions
accompanying the form, or as specified in the corresponding regulations.