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

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

2. Name and Complete Address of Importer of Record

Return Form to this Address

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

11. Country of Origin

12. Port of Entry

13. Name and Complete Address of Carrier

14. Entry Number

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. To be Completed for Pesticides without an EPA Registration Number (The following information is optional, but may expedite processing of the Notice of Arrival. Check all that apply and provide additional information as indicated) 18a. A pesticide transferred between registered establishments operated by the same producer. Domestic Producer Establishment Number: ________________________. 18b. A pesticide transferred between registered establishments not operated by the same producer. Domestic Producer Establishment Number ________________________ EPA Registration Number of Product being Formulated, if applicable: ________________________. 18c. A pesticide distributed under an Experimental Use Permit. Experimental Use Permit Number:______________________. 18d. A pesticide distributed for research and development purposes without an Experimental Use Permit. 18e. A pesticide transferred solely for export. Domestic Producer Establishment Number: _______________________ . 18f. A pesticide distributed under an emergency exemption. Emergency Exemption Number:____________________. 18g. A pesticide transferred for the purposes of disposal. 18h. Other. Provide an explanation including the intended use and a description of why the product is being imported into the United States in the Remarks (block 19).

19. Remarks (Provide additional information here. It is recommended that a copy of the label affixed to the product be submitted with the NOA.).

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

20. Printed Name of Importer of Record or Licensed Customs Broker

Telephone Number

21. Signature of Importer of Record or Licensed Customs Broker

Date Signed

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

Signature and Title of EPA Official

Date

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

Date

Paperwork Reduction Act Notice: The estimated average time to read the instructions and complete this form is 26 minutes. Send comments regarding the burden estimate or any other aspect of this collection of information to: Director, Collection Strategies Division, Office of Environmental Information (OEI), U.S. Environmental Protection Agency (Mail Code 2822), 1200 Pennsylvania Avenue, NW, Washington, DC 20460. Include OMB number 2070-0020 in any correspondence.

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 a copy of the label affixed to the product be submitted with each NOA. Additional supporting documentation (e.g. CBP Form 7501, 3461, or 3461 ALT) for validating information provided may also be included with the submission. 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 Complete 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 pesticide does not have an EPA registration number, it is recommended that “OTHER” be written in block 4 and block 18 be completed. If the product is a device, write the word “DEVICE” in block 4.

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. or the product is a device, 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.

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, rail, 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. Importation of Pesticides without an EPA Registration No. It is recommended that block 18 be completed for pesticides without an EPA Registration No. Check all that apply and provide additional information as indicated. The Domestic Producer Establishment No. is the EPA registered establishment where the imported product is transported after release by Customs, if applicable.

19. Remarks. This block may be used to provide additional information. It is recommended that a copy of the label affixed to the product be submitted with the NOA.

20. Printed Name of Importer of Record or Licensed Customs Broker. Print name and telephone number of the Importer of Record or Licensed Customs Broker.

21. 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 5 Post Office Square – Suite 100 Boston, MA 02109-3912	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 #205 2890 Woodbridge Ave. Edison, NJ 08837-3679	NJ, NY, PR, VI	EPA Region 7 Mail Code: WWPD/TOPE 11201 Renner Boulevard Lenexa, KS 66219-9605	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 Hawthorne 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