Form 8570-30 Pesticide Registration Maintenance Fee Filing Form

Form Approved. OMB No. 2070-0179
Expiration Date: 1/31/2025

EPA

United States Environmental Protection Agency

Pesticide Registration Maintenance Fee Filing Form

Paperwork Reduction Act Notice: This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB
Control No. 2070-0179). Responses to this collection of information are mandatory for certain persons, as specified at 40 CFR Part 152. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public
reporting and recordkeeping burden for this collection of information is estimated to be 1.17 hours per response. Send comments on the Agency’s need for
this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Information
Engagement Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB
control number in any correspondence. Do not send the completed form to this address.

A. Registrant Identification:
Please enter address here:
Company No.:

______________

Company Name: ________________________________________

B. EPA Company Number(s):
C. Maintenance Fee Calculation: Table to be Used (Circle One): Table A Table B Table C (Financial data required to use Tables B & C.)
1. Number of registrations on printout you will support by paying the fee:

______________

2. Number of registrations on printout already approved by EPA for transfer to another registrant:

______________

3. Number of registrations on printout previously canceled, or which you want EPA to cancel:

______________

4. Number of registrations on printout not counted in lines C1, C2, or C3:

______________

5. Number of active registrations omitted from the printout you will support by paying the fee:

______________

6. Total number of registrations you will support by paying the fee (C1 + C5):

______________

7. Amount due (See fee table in instructions. If using Table B or C, documentation required.):
8. Pay.gov Tracking ID or Electronic Transfer Ref. No. w/date (Checks no longer accepted.):

$ ______________
______________

Important! Registrations for which the fee is not paid will be canceled!

For the Maintenance Fee instructions, go to www.epa.gov/pesticide-registration/annual-pesticide-registration-maintenance-fees
or go to www.epa.gov/pesticides then A-Z Index under Tools, M and then Maintenance Fees.

D. Authorized Company Representative or Agent:
I certify that the statements that I have made on this form and all attachments thereto are true, accurate, and complete. I acknowledge that any knowingly
false or misleading statements may be punishable by fine or imprisonment or both under applicable law.
Name
Signature and Date

Title

Telephone

Please email the completed forms and
supporting documents to [email protected].
Do not send in by mail, Fed Ex, UPS, etc.
EPA Form 8570-30 (Rev. 09-24))

Email