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The document guides applicants through selecting application types, specifying disciplines and EPA-run jurisdictions, and calculating fees for jurisdictions, disciplines, and exam requirements. It collects applicant identity and contact details, requires submission of passport photographs with strict specifications, and covers reciprocity for initial certification. 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Firms should use the Application for Firms instead of this form. Please type or print responses in black or blue ink only.  \nA. General Information (All applicants)  \nSelect one of the following application types: Initial certification application  \nRe-certification application  \nAdding jurisdiction[s] to certification/amending certification Replacement of a badge  \nReplacement of a certificate  \nReplacement of a badge and certificate  \nOfficial Use Only  \nFor information on EPA and other Lead Programs, see:  \n[http://www.epa.gov/lead](http://www.epa.gov/lead)  \nIndicate the discipline(s) for which you seek certification or re-certification and all EPA-run jurisdiction(s) in which you intend to perform lead-based paint activities. For discipline-specific responsibilities, please see the instructions. An EPA-run jurisdiction includes an EPA-run state, U.S. territory, or all Indian tribal land(s) in any one EPA Region. You will be eligible for certification to work only in those EPA-run jurisdiction(s) you specify below. Attach additional sheets of paper, as necessary.  \nThe fee you must pay depends on the number of disciplines and EPA-run jurisdiction(s) in which you plan to conduct lead-based paint activities. See the fees schedule in the instructions to determine your fee. The total fee listed below should include fees calculated on any additional sheets.  \n\n| I=Initial\u003Cbr>R=Refresher | Inspector | Supervisor | Risk\u003Cbr>Assessor | Project\u003Cbr>Designer | Abatement\u003Cbr>Worker | Fee |\n| --- | --- | --- | --- | --- | --- | --- |\n|  | I R | I R | I R | I R | I R |  |\n| 1st EPA-run jurisdiction* (pay base certification fee only) |  |  |  |  |  | $ |\n| 2nd EPA-run jurisdiction* |  |  |  |  |  | $ |\n\nCheck here if you are listing additional EPA-run jurisdiction[s]  \nList each additional jurisdiction as necessary. (Each additional jurisdiction is $35 per discipline, per jurisdiction) $  \nCertification exam fee ($70 each) (Does not apply to project designers, abatement workers, or applicants applying under Section C) . $   \n*See the definition of EPA-run jurisdiction[s] and the fee examples in the instructions.  \nFor current listing of EPA-run jurisdictions, [see](see www.epa.gov/lead)[ ](see www.epa.gov/lead)[www.epa.gov/lead](see www.epa.gov/lead), or call 1-800-424-LEAD.  \nB. Applicant Information (All applicants)  \nCheck here if you are an employee of a Federally-recognized Indian Tribe.  \nMr. Mrs. Ms. Name:  \nLast First  \nPrevious and/or Maiden Name(s), if applicable:  \nBusiness Phone \\#: ext. Home Phone \\#:  \n*In the event that we cannot reach you, please list another contact name and number (optional):  \nHome Address:  \nStreet Address, Suite Number (Please no P.O. Box) Company Name and Address:  \nName Street Address, Suite Number  \nApplicant’s E-mail Address (optional) :  \nTo which address should correspondence or badge be sent? Home  \nCity  \nCity  \nCompany  \nTotal Fee: $  \nMiddle  \nState  \nState  \nOther (please attach)  \nZip Code  \nZip Code  \nForm Approved OMB No. 2070-0155 Expires 10/31/11  \nDate of Birth: Race/Ethnicity (optional):  \nMonth/Day/Year  \nCountry of Legal Residence: Gender: Male Female  \nHeight: Weight: Eye Color: Hair Color:  \nFeet Inches Pounds  \nSubmit two identical passport photographs of you alone, recent enough to be a good likeness (normally taken within the last 6 months) . As shown in the example to the right, photographs should be 2 x 2 inches in size with an image of your head and shoulders taking up the majority of the area. Photographs must be clea","cbCaic4xvdsoCobV","https://ap.wps.com/l/cbCaic4xvdsoCobV","pdf",1362048,14,"English","# Application for Individuals\n## General Information\n## Applicant Information\n## Reciprocity (Initial Certification)\n## Training\n## Experience and Education","[{\"question\":\"What application types are available for individuals applying to conduct lead-based paint activities?\",\"answer\":\"The form lists options including Initial certification application and Re-certification application, as well as requests such as adding jurisdictions and replacements of badges or certificates.\"},{\"question\":\"How do applicants indicate the disciplines and EPA-run jurisdictions where they plan to work?\",\"answer\":\"Applicants select the disciplines sought and identify all EPA-run jurisdictions intended for performing lead-based paint activities, with eligibility limited to the jurisdictions specified.\"},{\"question\":\"What are the requirements for passport photographs submitted with the application?\",\"answer\":\"Submit two identical passport photographs taken within the last six months. They must be 2 x 2 inches, clear, front view, full face, with head and shoulders filling most of the frame, and not retouched or in profile.\"}]","Application for Individuals to Conduct Lead-Based Paint Activities - Instructions | PDF",1791149519,35]