Attachment C - EPA Form 8570-25

United State Environmental Protection Agency

Office of Pesticide Programs (7504P)

Washington, DC 20460

Application for/Notification of State Registration

of a Pesticide to Meet a Special Local Need

(Pursuant to section 24(c) of the Federal Insecticide,

Fungicide, and Rodenticide Act, as Amended)

4. Product Name

Paperwork Reduction Act Notice

The public reporting burden for this collection is estimated to average 2.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining needed data and completing and reviewing this application 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, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. You can also send comments to the Office of Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, DC 20503, Attention: Desk Office for EPA.