                                       
     UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, D.C. 20460
Endocrine Disruptor Screening Program (EDSP)
FFDCA §408(p) Order/FIFRA §(3)(c)(2)(B) Data Call-In (DCI)
                                Clear Form Data
                           OMB Control No.
2070-TBD
  EDSP Tier 2 Testing, Initial Response Form for Individual Order Recipients
Paperwork Reduction Act Notice: The public reporting burden for this collection of information is estimated to average one hour per response. Send comments regarding the burden estimate to: Director, Collection Strategies Division (2822T), U.S. Environmental Protection Agency, Washington, DC 20460. Do not send the completed form to this address  -  follow the submission instructions in the order/DCI and Part 4 below.
Part 1
Recipient Information: (from the order/DCI and completed by the EPA)

A. Order/DCI #:
B. Date Issued:
C. Initial Response Due:
1.1. Order/DCI Info:



1.2. Company Name:

1.3. Address:



1.4. Contact Person:



A. Chemical #:
B. Chemical Name:
C. Company Number(s):
1.5. Chemical Info:



Part 2
Recipient's Initial Response: (Please check the box next to your preferred response (2.1  -  2.7).  Refer to the order/DCI for more information about response options, as well as detailed instructions on how to comply with the order/DCI.)
                                                                               
                                                                           2.1.

I will generate new data or am citing/submitting existing data. For each required test () below, check the appropriate box (A, B, or C) and follow the order/DCI instructions to attach the data and/or required documentation.

A. I will generate new data.

B. I am citing/submitting existing data and/or other scientifically relevant information.

C. I am entering (or offering to enter) into an agreement to form a Consortium/Task Force to respond to the order/DCI. 
The Consortium/Task Force must provide a separate initial response within 150 calendar days from issuance of the order/DCI. (See EDSP Tier 2 Testing, Initial Response Form for Consortia/Task Forces at http://www.epa.gov/endo/.)
                                                                       Required
Test
                                       A
                                       B
                                       C
                               Documentation is
                                   Attached
                                                                               
OCSPP Guideline 890.2100, Japanese Quail Two-Generation Toxicity
                                       
                                       
                                       
                                       
                                                                               
OCSPP Guideline 890.2200, Medaka Extended One-Generation Reproduction
                                       
                                       
                                       
                                       
                                                                               
OCSPP Guideline 890.2300, Larval Amphibian Growth and Development
                                       
                                       
                                       
                                       
                                                                               
OCSPP Guideline 870.3800, Reproduction and Fertility Effects*
                                       
                                       
                                       
                                       
                                                                               
*[OECD TG 416 (Two-Generation Reproduction Toxicity Study) or 
OECD TG 443 (Extended One-Generation Reproductive Toxicity Study) are acceptable alternatives to OCSPP Guideline 870.3800]
                                       
                                       
                                       
                                       
                                      2.2
                                       
I am not subject to the order/DCI.

These Response Options Apply Only to Registered Pesticides:
                                                                            2.3
I intend to voluntarily cancel the pesticide registration(s).
                                       
                                                                            2.4
I intend to reformulate the product(s) to exclude this chemical from the formulation.
                                       
                                                                            2.5
I am claiming a formulator's exemption.
                                       
These Response Options Apply Only to Pesticide Inert Ingredients (aka, Inerts):
                                                                            2.6
I have/am in the process of discontinuing the manufacture/import of this chemical.
                                       
                                                                            2.7
I do not and will not sell my chemical for use as an inert ingredient to the pesticide market.
                                       
Part 3
3.1. Certification: 
I certify that the statements made on this form and all attachments 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.
                                                                            3.2
Company's Authorized Representative
3.3 Date
                                                                     Signature:


                                                              Name & Title:

3.4 Telephone Number
                                                                 Email Address:


Part 4
Detailed submission instructions can be found on the EPA's EDSP Internet homepage at http://www.epa.gov/endo.
EPA Form No. 6300-07 (Draft, June 2015)
