Rutgers, The State University of New Jersey

IR-4 Minor Use Biopesticide Project Clearance Request (PCR) Form

Printable PDF version of this for is available HERE.

Electronic submission below is entered automatically into a request database and email notification is sent to the appropriate IR-4 personnel.

If you submit incorrect information or need to modify your request, please contact IR-4 personnel at (732) 932-9575 ext. 4610 or email Michael Braverman

IMPORTANT: The more information we receive on these forms, the more quickly we can schedule and complete a study and get a new use registered!

Please note blue fields are required.

1 REQUESTOR

Name:

Affiliation:

Address:

City:

State:

Zip:

Telephone:

Fax:

Email:

2. PEST CONTROL PRODUCT:

Active Ingredient {a.i.}:

TradeName/Formulation:

Registrant (manufacturer):

Method of Production (fermentation, in vivo, extraction from plants):

3. COMMODITY (one crop or crop group per form)

Commodity:

Use Site (e.g., field, greenhouse, post-harvest):

Parts Consumed:

Animal Feed By-Products: Yes No

Planting Season:

Harvest Season:

State/Territory Acreage:

% National Acres:

Average Field Size:

4. PEST/DISEASE/WEED/PLANT GROWTH REGULATOR:
Damage caused by pest/disease/weed:

5. WHY IS THIS USE NEEDED:

6. PROPOSED LABEL INSTRUCTIONS:

Rate per Application (lbs a.i. per acre or 1000linear ft.

Type of sprayers that may be used (e.g., fixed wing, ground boom sprayer, chemigation, air blast, ULV, granular spreader)

Range of Spray Volume (if applicable)

Maximum Acreage Treated per Day:

Crop Stage during Application(s):

Maximum no. of applications:

Minimum interval between applications:

Maximum lbs active ingredient per acre per year/season:

PHI:

7.AVAILABILITY OF SUPPORTING DATA*:

Phytotoxicity (P): Yes No

Efficacy (E): Yes No

Yield (Y): Yes No

*Send email with attachments to Michael Braverman after submission of this form.
8. BRIEF SUMMARY OF PROPOSED STUDY AND FUND REQUEST:

IR-4 Project, Center for Minor Crop Pest Management
500 College Road East, Princeton, NJ 08540 Telephone (732)932-9575 ext 4610 FAX (609)514-2612
or e-mail Michael Braverman braverman@aesop.rutgers.edu