Rutgers, The State University of New Jersey

IR-4 Minor Use Project Clearance Request Form

This information 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. 4620 or email Diane Infante

Please note blue fields are required.

1. REQUESTER

Name:
Affiliation:
Address:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

2. PESTICIDE (Common Name/Mfg):

3. COMMODITY

Crop:

Use Site:

Parts Consumed:

Animal Feed By-Products:

Planting Season:

Harvest Season:

Local Acreage:

% National Acres:

4. POTENTIAL INTERNATIONAL CONSIDERATIONS:

Is this an export commodity: Yes No

Key Export Markets:

Are there MRLs established in key export markets?: Yes No

Which markets?:

5. TARGET PESTS/POTENTIAL EFFECTS:

6. WHY IS THIS USE NEEDED:

7. PROPOSED LABELLING:

Trade Name

Dosage Rate (Active/Acre)

Type Of Application (e.g. foliar, soil, seed treatment, etc):

Number of Applications:

Re-treatment Interval (Days):

PHI (days):

Directions of Use

Limitations

Special Safety Precautions

8. SUPPORTING DATA *

Phytotoxicity (P): Yes    No

Efficacy (E): Yes    No

Yield (Y): Yes    No

*Send email with attachments to Diane Infante after submission of this form.