STATE OF CALIFORNIA

ORGANIC INPUT MATERIAL LABEL DEPARTMENT OF FOOD AND AGRICULTURE

REGISTRATION APPLICATION DIVISION OF INSPECTION SERVICES
513-026 (REV.05/2022) FEED, FERTILIZER, AND LIVESTOCK DRUGS
REGULATORY SERVICES

COMPLETE ALL FIELDS

Do you have a fertilizing materials license?
No - Submit a fertilizing materials license application
Yes - Enter firm name as name as it appears on the license and label:

Firm Name Firm ID

Full Name of Applicant (owner or owners)

LICENSED ADDRESS AS IT APPEARS ON THE LABEL

Street number City/town State Postal Code County

Type of Organic Input Material. Please check ALL that may apply:
Agricultural mineral Specialty fertilizer Commercial fertilizer
Auxiliary soil and plant substance Soil amendment Not sure

Please submit the following REQUIRED documentation:

■ Agreement Form (OIM-0002); ■ Method and Ingredient Declaration (OIM-0010); ■ Complete
Formula of Material (OIM-0013); ■ Complete description of the manufacturing process for each
ingredient and the final product; ■ Intended use of product; ■ Supplier of ingredients; ■ Alternate
formulations; ■ Third party formulated ingredients; ■ Invoices or weight tickets for each ingredient;
■ Analysis (pathogen, heavy metals, etc.), if applicable; ■ Any additional information supporting
compliance with the National Organic Program standards; and ■ One 8 ½ x 11 inch copy of
labeling - larger sizes are unacceptable. Ensure that ALL text is legible on the copy submitted.
Failure to submit documentation may result in a delay of processing your application

By submitting this application for a registration or review of a fertilizing material label, I

acknowledge that the following information from this record is placed in the public domain: licensed
firm name, license ID, product name, organic input material (Yes/No), Annotations, registration ID,
Status, label nutrient guarantees, heavy metals, and Fertilizing Material Product Type.
I certify that the information contained in this application is true and correct.

Signature of authorized representative

Type or clearly print name Date

Registration applications(s) and fee(s) may be directly submitted online through the Feed,
Fertilizer, And Livestock Drugs Regulatory Services ExtraView database available at:
https://inspect.cdfa.ca.gov/

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ORGANIC INPUT MATERIAL
LABEL REGISTRATION APPLICATION
513-026 (REV.05/2022)

The fee for an organic input material label registration is five hundred dollars ($500.00).

This is a label review fee. It is not refundable and will not be prorated.

Make check payable to: CDFA-418

Submit completed and signed application with all documentation DEPARTMENT USE ONLY
and the registration fee to:
RC NUMBER
CDFA, ISD, FFLDRS, OIM FEE $
P.O. BOX 942875
RC DATE
SACRAMENTO, CA 94271-2875
PENALTY $
DO NOT SEND COIN OR CURRENCY

INCOMPLETE APPLICATIONS CANNOT BE PROCESSED AND WILL BE RETURNED.

BE SURE TO FILL OUT ALL FIELDS ON BOTH PAGES.

IS THIS A LIQUID
PRODUCT NAME WETTING AGENT
PRODUCT?
CONFIDENTIAL?
Yes Yes
No No
CONFIDENTIAL?
Yes Yes
No No
CONFIDENTIAL?
Yes Yes
No No
CONFIDENTIAL?
Yes Yes
No No
CONFIDENTIAL?
Yes Yes
No No
CONFIDENTIAL?
Yes Yes
No No
CONFIDENTIAL?
Yes Yes
No No

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