Form 8570-32 Cert. Attempt Agreement

United States Environmental Protection Agency
Washington, D.C. 20460
CE RT IFICAT ION OF ATT EM PT TO ENTE R INTO AN
AGREEMENT WITH REGISTRANTS FOR
DEVELOPMENT OF DATA

Form App rove d.
OM B N os. 2070 -005 7;
2070-0107; 2070-0122;
2070-0164

Paperwork Reduction Act Notice: Th e pu blic rep orting burd en fo r this co llection o f inform ation is estim ated to
average 15 minutes per response including time for reading the instructions, searching existing data sources, gathering
and maintaining the data needed and completing and reviewing the collection of information. Send comm ents regarding
the burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden
to: Director, Collection Strategies Division (2822T), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue,
N.W ., W ashington, DC 20460. Do not send the form to this address.
Please fill in blanks below
Company Name

Company Number

Chemical Name

EPA Chemical Number

I Certify that:
My company is willing to develop and submit the data required by EPA under the authority of the Federal Insecticide,
Rodenticide and Fungicide Act (FIFRA), if necessary. However, my company would prefer to enter into an agreement
with one or more registrants to develop jointly or share in the cost of developing data.
My firm has offered in writing to enter into such an agreement. That offer was irrevocable and included an offer to be
bound by arbitration under section 3(c)(2)(B)(iii) of FIFRA if final agreement on all terms could not be reached
otherwise. This offer was m ade to the following firm (s) on the following date(s):
Name of Firm(s)

Date of Offer

Certification:
I certify that I am duly authorized to represent the company name above, and that the statements that I have made on
this form and all attachments therein 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.
Signature of Company’s Authorized Representative

Name and Title (Please Print or Type)

EPA Form 8570-32 (12-2003)

Date