Kansas Department of Agriculture

Pesticide and Fertilizer Program

Statement Submission

Please indicate the type of statement you want to submit.
 
Damage Claim:  The statement of claim of damage from pesticide application is defined in K.S.A. 2-2457a.  The purpose of this statement is to inform those you believe to be responsible for your damage. We will send the information you submit to those you identify as responsible.  We will need a mailing address or email for anyone you believe responsible for the damage.  Please note: The alleged damage-causing pesticide application may be a legitimate application or a misuse. If you believe misuse is involved, the damage claim form will give you the opportunity to provide that information - you won't need to fill out a separate pesticide misuse form.
 
Pesticide Misuse: Use this form to provide your contact information and the first-hand knowledge you have of non-compliant storing, loading, mixing, and/or application of pesticides. 
 
Please do not start with the Pesticide Misuse form if you are alleging damage from a pesticide application.  Please start with the damage claim form.  You will have the opportunity to describe any evidence you may have of a misuse after describing your damage.
 
Other complaint: Use this form to provide your contact information and the first-hand knowledge you have of a non-compliance other than pesticide misuse.  Do not use this form if you are alleging damage from a pesticide application - use the damage claim form.
 
Anonymous Tip: Use this form if you wish to remain anonymous but report first-hand information of a non-compliance with one or more of our laws.  Do not use this form if you are alleging damage from a pesticide application - use the damage claim form.
Statement Type: *
Kansas Open Records Act, K.S.A. 45-215, et  seq. *