                                       
     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 Consortia/Task Forces
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
Primary Contact Information: (i.e., the Administrator of the Consortium/Task Force

A. Chemical #:
B. Chemical Name:
1.1. Chemical Info:


1.2. Company/ Consortium/ Task Force Name:

1.3. Address:



1.4. Contact Person:


Part 2
Consortium/Task Force's Initial Response: (Please 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.
For each assay, check the appropriate box to indicate the Consortium/Task Force's initial response (A or B) below for those tests indicated as required () and follow the order/DCI instructions to attach the data and/or required documentation.

A. The Consortium/Task Force will generate new data.

B. The Consortium/Task Force is citing/submitting existing data and/or other scientifically relevant information.
                                                                       Required
Test
                                       A
                                       B
                                 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
The Consortium/Task Force is citing and/or submitting other scientifically relevant information that it believes can be used to satisfy the entire order/DCI
Part 3
Consortium/Task Force Participants: (Please list all participants, including recipient information from the order.)
3.1. Order/DCI #:
3.2. Company Name(s):
3.3. Company Number(s):
3.4. Contact Name/Phone No.:
EDSP - 









EDSP - 









EDSP - 









EDSP - 









EDSP - 









EDSP - 









 See attached continuation sheet identifying additional participants in the Consortium/Task Force.
 See attached copy of the Consortium/Task Force agreement.
Part 4
4.1. 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.
                                                                            4.2
Consortium/Task Force's Authorized Representative
4.3 Date
                                                                     Signature:


                                                              Name & Title:

4.4 Telephone Number
                                                                 Email Address:


Part 5
Detailed submission instructions can be found on the EPA's EDSP Internet homepage at http://www.epa.gov/endo.
EPA Form No. 6300-07-C (Draft, June 2015)
