Information Collection

Pesticide Applicators

IC 199392 under ICR 201109-2040-001 · OMB 2040-0284.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2040-0284 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ADVERSE INCIDENT WRITTEN REPORT Pesticide Applicators	Form and Instruction
Form 2 ANNUAL REPORTING FORM Pesticide Applicators	Form and Instruction
Form 3 NOTICE OF INTENT (NOI) Pesticide Applicators	Form and Instruction
Form 4 NOTICE OF TERMINATION (NOT) Pesticide Applicators	Form and Instruction
Form 5 PESTICIDE DISCHARGE EVALUATION WORKSHEET Pesticide Applicators	Form and Instruction
1 ADVERSE INCIDENT WRITTEN REPORT 2397supp01 - PGP ICR Adverse Incident Form.pdf	Form and Instruction
2 ANNUAL REPORTING FORM 2397supp01 - PGP ICR Annual Report Form.pdf	Form and Instruction
3 NOTICE OF INTENT (NOI) 2397supp01 - PGP ICR NOI Form.pdf	Form and Instruction
4 NOTICE OF TERMINATION (NOT) 2397supp01 - PGP ICR NOT Form.pdf	Form and Instruction
5 PESTICIDE DISCHARGE EVALUATION WORKSHEET 2397supp01 - PGP ICR PDEW Form.pdf	Form and Instruction

IC Title:

Pesticide Applicators

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 40 CFR 122

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Yes	No	Printable Only
Form and Instruction	2	Yes	No	Printable Only
Form and Instruction	3	Yes	No	Printable Only
Form and Instruction	4	Yes	No	Printable Only
Form and Instruction	5	Yes	No	Printable Only

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 365,000

Number of Respondents for Small Entity: 4,289

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,277,083	1,277,083
Annual IC Time Burden (Hours)	841,037	841,037
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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