Ppq Form 526 - Application For Permit To Move Live Plant Pests Or Noxious Weeds

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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information

OMB APPROVED

unless it displays a valid OMB control number. The valid OMB control numbers for these information collections are 0579-0054 and 0579-0213. The time

0579-0054 and 0579-0213

required to complete this information collection is estimated to average 0.17 hours per response, including the time for reviewing instructions, searching existing

EXP DATE XX//XXXX

data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

No permit can be issued to move live plant pests or noxious weeds until an application is received (7 CFR 330 (live plant pests) or 7 CFR 360 (noxious weeds)).

U.S. DEPARTMENT OF AGRICULTURE

SECTION A - TO BE COMPLETED BY THE APPLICANT

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

1. NAME, TITLE, AND ADDRESS (Include ZIP Code)

PLANT PROTECTION AND QUARANTINE

PERMITS AND RISK ASSESSMENT, UNIT 133

RIVERDALE, MARYLAND 20737

APPLICATION FOR PERMIT TO MOVE

LIVE PLANT PESTS OR NOXIOUS WEEDS

3. TYPE OF PEST TO BE MOVED

Pathogens

Arthropods

Noxious Weeds

Other (Specify) _______________________________________

This permit does not authorize the introduction, importation, interstate

movement, or release into the environment of any genetically

2. TELEPHONE NO. (

)

engineered organisms or products.

B. CLASSIFICATION

LIFE

D. NO. OF

ARE PESTS

SCIENTIFIC NAMES OF

(Orders, Families, Races,

STATES, IF

SPECIMENS

SHIPPED FROM

ESTABLISHED IN

MAJOR HOST(S)

or Strains)

APPLICABLE

OR UNITS

U.S.?

PESTS TO BE MOVED

OF THE PEST

(Country or State)

7. WHAT HOST MATERIAL OR SUBSTITUTES WILL ACCOMPANY WHICH PESTS (Indicate by line number)

8. DESTINATION

9. PORT OF ARRIVAL

10. APPROXIMATE DATE OF ARRIVAL OR INTERSTATE

MOVEMENT

11. NO. OF SHIPMENTS

12. SUPPLIER

13. METHOD OF SHIPMENT

Air Mail

Air Freight

Baggage

Auto

14. INTENDED USE (Be specific, attach outline of intended research)

15. METHODS TO BE USED TO PREVENT PLANT PEST ESCAPE

16. METHOD OF FINAL DISPOSITION

17. Applicant must be a resident of the U.S.A.

SIGNATURE OF APPLICANT (Must be person named in Item 1)

18. DATE

I/We agree to comply with the safeguards printed on the

reverse of this form, and understand that a permit may be

subject to other conditions specified in Section B and C.

WARNING:

Any alteration, forgery, or unauthorized use of this document is subject to civil penalties of up to $250,000 (7 U.S.C. s7734(b)) or punishable by a fine of not more than $10,000, or

imprisonment of not more than 5 years, or both (18 U.S.C. s1001).

SECTION B - TO BE COMPLETED BY STATE OFFICIAL

19. RECOMMENDATION

20. CONDITIONS RECOMMENDED

Concur

Comments

(Approve)

(Disapprove)

(Accept USDA Decision)

21. SIGNATURE

22. TITLE

23. STATE