Information Collection

Pesticide Applicators

IC 199392 under ICR 201611-2040-001 · OMB 2040-0284.

Documents and Forms

Document Name Document Type
Form 6100-22; 6100-23; Pesticide Applicators Form and Instruction
6100-22; 6100-23; Notice of Intent; Notice of Termination; Pesticide Disch 2397ss02_APP D (03122014).pdf water.epa.gov/polwaste/npdes/basics/eNOI.cfm Form and Instruction
6100-23 Notice of Termination Final2016AppendixE-NOT form_FINAL.pdf www.epa.gov/npdes/pesticide-permitting Form and Instruction
6100-22 Notice of Intent Final2016AppendixD-NOI form_FINAL.pdf www.epa.gov/npdes/pesticide-permitting Form and Instruction
6100-26 Pesticide Discharge Evaulation Worksheet (PDEW) Final2016AppendixF-PDEW form_FINAL.pdf www.epa.gov/npdes/pesticide-permitting Form and Instruction
6100-25 Annual Report Template Final2016AppendixG-Annual Report form_FINAL-Final.pdf www.epa.gov/npdes/pesticide-permitting Form and Instruction
6100-24 Adverse Incident Report Template Final2016AppendixH-Adverse Incident form_FINAL.pdf www.epa.gov/npdes/pesticide-permitting 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: Modified

Obligation to Respond: Mandatory

CFR Citation: 40 CFR 122

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6100-22; 6100-23; 6100-26; 6100-25; 6100-24	Notice of Intent; Notice of Termination; Pesticide Discharge Evaluation Sheet; Annual Report; Adverse Incident Report	2397ss02_APP D (03122014).pdf	http://water.epa.gov/polwaste/npdes/basics/eNOI.cfm	Yes	Yes	Fillable Fileable
Form and Instruction	6100-23	Notice of Termination	Final2016AppendixE-NOT form_FINAL.pdf	https://www.epa.gov/npdes/pesticide-permitting	Yes	Yes	Fillable Fileable
Form and Instruction	6100-22	Notice of Intent	Final2016AppendixD-NOI form_FINAL.pdf	https://www.epa.gov/npdes/pesticide-permitting	Yes	Yes	Fillable Fileable
Form and Instruction	6100-26	Pesticide Discharge Evaulation Worksheet (PDEW)	Final2016AppendixF-PDEW form_FINAL.pdf	https://www.epa.gov/npdes/pesticide-permitting	Yes	Yes	Fillable Fileable
Form and Instruction	6100-25	Annual Report Template	Final2016AppendixG-Annual Report form_FINAL-Final.pdf	https://www.epa.gov/npdes/pesticide-permitting	Yes	Yes	Fillable Fileable
Form and Instruction	6100-24	Adverse Incident Report Template	Final2016AppendixH-Adverse Incident form_FINAL.pdf	https://www.epa.gov/npdes/pesticide-permitting	Yes	Yes	Fillable Fileable

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	Previously Approved
Annual Number of Responses for this IC	1,276,395	1,276,395
Annual IC Time Burden (Hours)	828,141	828,141
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.