Pesticide Forms

PESTICIDE APPLICATIONS

Application for License of Pesticides and Non-Chemical Pest Control Devices – Use this form for new product licensing including products whose name or formulation has changed. Submit one application along with a copy of the Confidential Statement of Formula, the EPA Stamped approved label, the final printed label and a payment of $930.00 for each product.  See “Instructions for Form P-2” for additional requirements.

Application for License Renewal of Pesticides – Beginning July 1 or shortly after, renewal notices are sent to licensees who have products with licenses that expire on December 31 of the current calendar year. A renewal notice includes an application form that is preprinted with the list of the licensing company’s pesticide products eligible for renewal, along with their respective EPA registration and State license numbers. To renew licenses, submit the completed application form, and the applicable license fees according to the directions in the renewal notice.

If, after August 1, you have not received a form and believe you have products whose licenses expire at the end of the current calendar year, send an email inquiry to [email protected]

For discontinued products, licenses must be maintained for as long as the product(s) remain in the channels of trade, for at least one three-year license period following receipt of written notification of discontinuance by the Pesticides Branch. Licensees may apply to renew a license for a discontinued product for 1 or 2 years by submitting documentation that the product will have exited the channels of trade by the end of the requested license period. I using the pre-printed renewal application form, indicate any products to be placed in discontinuance on the renewal form.

Electronic Submissions – While P-2 and P-2-2019 forms (with an original signature), and payment of licensing fees must be submitted via regular mail, electronic submission of supporting documents is preferred.  We ask that documents be in pdf format, text-searchable, and without any security to allow insertion of our licensing stamp.  A copy of the license certificate, label and receipt for payment will then be e-mailed back to you.  Even if not making electronic submissions, please be sure to include the e-mail address of the responsible party on the P-2 and P-2-2019 forms.

Electronic submissions may be sent to the following e-mail address: [email protected]

Experimental Use Permit (EUP) Application – Complete this form for conducting trials involving the evaluation of pesticides to determine the scope and limitations of its usefulness and the effect of its use on humans and the environment.  (See Administrative Rules, Section 4-66-45 through 4-66-51 for specific EUP requirements)

Notice: Effective October 1, 2019, written notification to the Pesticides Branch will be required for laboratory, enclosed space production and limited field trials that may not require an Experimental Use Permit. See §4-66-47 in EUP requirements.

Restricted Use Pesticide (RUP) Sales Record Form – For use by RUP dealers.  (Not for hydrated lime sales.)

APPLICATORS AND RUP DEALER REPRESENTATIVE CERTIFICATION / RECERTIFICATION

Examinations are normally administered once a week.  Contact your district pesticide branch office (indicated on the application) to schedule an examination date.  Examination fees are as follows:

$50.00 per examination

$100.00 per initial certification card issued

$50.00 per replacement card

Form P-18.1   Application for Certification / Recertification of Private Applicators

Form P-17.1   Application for Certification / Recertification of Commercial Applicators

Form P-28-1   Application For RUP Dealer Representative License 

Form P-28-2   Application For RUP Dealer Representative License Renewal

(Last updated February 15, 2011)

FORMS RELATING TO ACT 45 (effective 2019)

For forms required under Act 45 (Annual Restricted Use Pesticide Reporting, Chlorpyrifos Use Permit) go to: http://hdoa.hawaii.gov/pi/main/act45/

 

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