Attachment E: EPA Form 3540-1

United States Environmental Protection Agency
Washington, DC 20460

Notice of Arrival of
Pesticides and Devices

Send Completed Form to
Appropriate Regional Office Listed
in the Instructions for this Form.

OMB Control No. 2070-0020
Approval Expires mm/dd/yyyy

Note: Read Instructions before completing form.

Part I: To Be Completed by Importer of Record or Licensed Customs Broker
1. Name and Complete Address of Licensed Customs Broker

Return Form to this Address

2. Name and Complete Address of Importer of Record

Return Form to this Address

3. Name and Complete Address of Shipper

4. EPA Registration Number

5. EPA Producer Establishment No.

6. Brand name of Product

7. Active Ingredients and Percentage of Each

8. Unit Size

9. Quantity

10. Total Net Weight

12. Port of Entry

14. Entry Number

11. Country of Origin

13. Name and Complete Address of Carrier

15. Anticipated Entry Date

17. Location of Goods for Examination after Importation

16. I assert that information constituting Confidential Business
Information is shown in the above blocks numbered: (Note: Blocks 4, 5,
6, 7 are not entitled to CBI treatment–see Instructions)

18. Remarks

Certification
I certify that the statements I have made on this form and all attachments thereto 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
19. Printed Name of Importer of Record or
Licensed Customs Broker

Telephone Number

20. Signature of Importer of Record or Licensed
Customs Broker

Date Signed

OMB Control No. 2070-0020·Approval Expires mm/dd/yyyy

Part II: To Be Completed by U.S. Environmental Protection Agency
Action to be taken by U.S. Customs and Border Protection
Release Shipment

Detain for Inspection

Release shipment to consignee under bond. Shipment must
be held intact pending inspection.

Other (Specify)
Remarks

Date

Signature and Title of EPA Official

Part III: To Be Completed by U.S. Customs and Border Protection
The information shown in Part I was compared with the entry papers for this shipment and no discrepancies were noted. The shipment
was handled as instructed by EPA in Part II. Any deviations should be brought to the attention of EPA before releasing shipment and
should also be noted in “Remarks.”
Remarks

Signature of District Director of Customs

EPA Form 3540-1 (Rev. #-##)

Date

OMB Control No. 2070-0020·Approval Expires mm/dd/yyyy

Instructions
U.S. Customs and Border Protection (CBP) Regulations. 19 CFR 12.112 requires an importer desiring to import
pesticides or devices into the United States to submit EPA Form 3540-1, Notice of Arrival of Pesticides and
Devices (NOA) to the U.S. Environmental Protection Agency (EPA) prior to the arrival of shipment in the United
States. The NOA will be used by: Importer of Record or Licensed Customs Broker: The importer of record or
licensed customs broker must complete Part I of the NOA form. A separate NOA must be submitted for each
pesticide or device in each shipment prior to its arrival at the port of entry. To expedite the handling of pesticide or
device shipments, submit NOA(s) to the EPA office listed below having jurisdiction over the state/territory of the
port of entry. It is recommended that all applicable blocks in Part I be completed prior to submission to EPA and
that supporting documentation (e.g. a product label and either CBP Form 7501, 3461, or 3461 ALT) for validating
information provided be included with the submission of each NOA. When providing an address, the complete
address should include the mailing location, email address, and telephone number of the contact person. EPA: EPA
will complete Part II, indicating the disposition of the shipment, sign and return the NOA(s) to the importer or
agent for presentation to CBP at the time of entry. CBP: CBP will compare the information shown on the NOA(s)
with the entry documents and the shipment, bringing any discrepancies to EPA’s attention before the shipment is
released, and noting discrepancies in the Remarks section. If the importation is not handled by CBP in the manner
instructed in Part II, this should also be noted in the Remarks. After completing Part III and signing the NOA(s),
CBP will return the NOA(s) to EPA as the Official File Copy.

1. Name and Complete Address of the Licensed Customs Broker. Person (such as private individual,
partnership, association or corporation) who is licensed, regulated and empowered by CBP to assist and transact on
behalf of others (importers and exporters) in meeting Federal requirements governing imports and exports (customs
business).
2. Name and Complete Address of the Importer of Record. Owner, purchaser, or when designated by the owner,
purchaser, or consignee, an authorized agent acting on importer’s behalf. The importer of record is the individual
or firm liable for payment of all duties and meeting all statutory and regulatory requirements incurred as a result of
importation.
3. Name and Address of Shipper. The name and address of person primarily responsible exporting the pesticide to
the United States.
4. EPA Registration No. The pesticide product registration number assigned at the time of registration that
identifies the product. The product registration number must be an approved EPA Registration No. as it appears on
the pesticide product label. If the product is a device, write the word “DEVICE” in this block. If the pesticides
product does not have an EPA-approved registration number or is not a device, to expedite review of the NOA, it is
recommended that “OTHER” be entered and an explanation, including the intended use and a description of why
the product is being imported into the United States, be provided in the remarks.
5. EPA Producer Establishment No. The EPA Producer Establishment No. that appears on the pesticide or device
product label. The EPA Producer Establishment No. on the product label is the final establishment where the
product was produced prior to shipment to the U.S. Foreign establishments that produce pesticides or devices for
distribution in the United States are required to have an EPA-registered producer establishment number.
6. Brand Name of Product. Name of the product as it appears on the label at the time of import.
7. Active Ingredients and Percentage of Each. List each active ingredient by percentage of each. If block 4
contains an EPA Reg. No., this block may be left blank. To expedite review of the NOA, it is recommended that
each active ingredient and percentage be listed to ensure accuracy of information.
8. Unit Size. Net weight or net contents as identified on the product label of the pesticide or device in the
immediate container, not including the wrapper or other packaging materials.
9. Quantity. Number of units.
10. Total Net Weight. Unit size multiplied by quantity.

EPA Form 3540-1 (Rev. #-##)

OMB Control No. 2070-0020·Approval Expires mm/dd/yyyy

11. Country of Origin. The country of manufacture, production, or formulation of the pesticide or device of
foreign origin entering the United States.
12. Port of Entry. The port of entry where the pesticide or device offered for import is processed for entry into the
United States. Ports of entry are designated locations where CBP enforces the import and export laws and
regulations of the United States federal government. Ports of entry are under the jurisdiction of a CBP port
director.
13. Name and complete address of the carrier. The carrier is a person or carrier service (ship, airline, or trucking)
who undertakes to transport goods or merchandise to and across the U.S. border.
14. Entry Number. The 11-character entry number using the format XXX-NNNNNNN-N, including the hyphens.
15. Anticipated Entry Date. Anticipated date of entry into the United States or anticipated date when the pesticide
or device will arrive within the port of entry limits.
16. Confidential Business Information (CBI) designation. Please note that the information provided in blocks
4,5, 6, and 7 is not entitled to confidential treatment under section 7(d) of FIFRA and under labeling requirements
for pesticides at 40 CFR 156.10. Information provided in those blocks will be made public with no further notice.
17. Location of Goods for Examination after Importation. Enter the physical address of the location of goods
for examination after importation. In the case of unregistered pesticides products imported between establishments
operated by the same or different producer(s), enter the EPA establishment number for the importing registered
establishment.
18. Remarks. This block may be used to provide additional information.
19. Printed Name of Importer of Record or Licensed Customs Broker. Print name and telephone number of the
Importer of Record or Licensed Customs Broker.
20. Signature of Importer of Record or Licensed Customs Broker. Signature of Importer of Record or Licensed
Customs Broker.

EPA Regional Offices

States and Ports of Entry
Locations in the US

EPA Regional Offices

States and Ports of Entry
Locations in the US

EPA Region 1
1 Congress Street (SEA)
Boston, MA 02114-2023

CT, MA, ME, NH, RI, VT

EPA Region 6
445 Ross Avenue
Suite #1200 (6PD-P)
Dallas, TX 75202-2733

AR, LA, NM, OK, TX

EPA Region 2
MS-500, Bldg #5
2890 Woodbridge Ave.
Edison, NJ 08837-3679

NJ, NY, PR, VI

EPA Region 7
901 N. 5th Street (PESTWWPD)
Kansas City, KS 66101

IA, KS, MO, NE

EPA Region 3
1650 Arch Street (3WC32)
Philadelphia, PA 19103-2029

DE, DC, MD, PA, VA, WV

EPA Region 8
1595 Wynkoop Street
Denver, CO 80202-1129

CO, MT, ND, SD, UT, WY

EPA Region 4
61 Forsyth Street, SW
(APT-PS)
Atlanta, GA 30303-8960

AL, FL, GA, KY, MS, NC,
SC, TN

EPA Region 9
75 Hawwthorne Street (CED-5)
San Francisco, CA 94105-3901

AZ, AS, CA, GU, HI, NV,
PI, WK

EPA Region 5
77 West Jackson Blvd.
(DT-8J)
Chicago, IL 60604-3507

IL, IN, OH, MI, MN, WI

EPA Region 10
1200 Sixth Avenue,
Suite 900 (ECO-084)
Seattle, WA 98101-3140

AK, ID, OR, WA

EPA Form 3540-1 (Rev. #-##)