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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	ADVERSE INCIDENT WRITTEN REPORT	2397supp01 - PGP ICR Adverse Incident Form.pdf	Yes	No	Printable Only
Form and Instruction	2	ANNUAL REPORTING FORM	2397supp01 - PGP ICR Annual Report Form.pdf	Yes	No	Printable Only
Form and Instruction	3	NOTICE OF INTENT (NOI)	2397supp01 - PGP ICR NOI Form.pdf	Yes	No	Printable Only
Form and Instruction	4	NOTICE OF TERMINATION (NOT)	2397supp01 - PGP ICR NOT Form.pdf	Yes	No	Printable Only
Form and Instruction	5	PESTICIDE DISCHARGE EVALUATION WORKSHEET	2397supp01 - PGP ICR PDEW Form.pdf	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 %

	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

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.