PPQ 526 Application for Permit to Move Live Plant Pests or Noxio

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 unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0049, 0054, and 0207. The time required to complete this information collection is estimated to average .17 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved 0579-0049, 0054 and 0207

united states department of agriculture animal and plant health inspection service Plant Protection and quarantine Permits and risk assessment, unit 133 riverdale, maryland 20737 Application for permit to move live plant pests or noxious weeds

Section a – to be completed by the applicant

1. name, title, and address (Include ZIP Code)

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 engineered organisms or products.

2. telephone No. ( )

A. Scientific names of Pest to be moved

B. Classification (Orders, Familites, Races, or Strains)

C. Life States, If Applicable

D. NO. OF Specimens or Units

E. Shipped from (Country or State)

F. Are Pest Established in U.S.?

G. Major Host(s) of the Pest

4.

5.

6.

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. 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 Sections B and C.

Signature of applicant (Must be person named in Item 1)

18. DATE

Warning: Any alteration, forgery, or unauthorized use of this document is subject to civil penalties of up to $250,000 (7 U.S.C. 7734(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. 1001)

Section B – To be completed by state official

19. recommendation

20. Conditions Recommended

Concur (Approve) (Accept USDA Decision)

Comments (Disapprove)

21. signature

22. Title

23. State

24. Date

Section C – To be completed by federal official

25. Permit No.

permit (Permit not valid unless signed by an authorized Official of the Animal and Plant Health Inspection Service) Under authority of the Plant Protection Act of 2000, permission is hereby granted to the applicant named above to move pests described, except as deleted, subject to conditions stated on, or attached to this application. (See standard conditions on reverse side.) * For exotic plant pathogens, attach a completed PPQ Form 526-1.

26. Signature of plant protection and quarantine official

27. Date

28. labels issued

29 valid until

30. pest category

PPQ FORM 526 Previous editions are obsolete.

MAY 2009

STANDARD SAFEGUARDS OF PERMIT

1. All pests must be shipped in sturdy, escape-proof containers.

2. Upon receipt of pests, all packing material media, substrate, soil and shipping containers shall be sterilized or destroyed immediately after removing pests.

3. Pests shall be kept only within the laboratory or designated area at the permittee's address.

4. No living pests kept under this permit shall be removed from confined area except by prior approval from State and Federal regulatory officials.

5. Without prior notice and during reasonable hours, authorized PPQ and State regulatory officials shall be allowed to inspect the conditions under which the pests are kept.

6. All pests kept under this permit shall be destroyed at the completion of the intended use, and not later than the expiration date, unless an extension is granted by this issuing office.

7. All necessary precautions must be taken to prevent escape of pests. In the event of an escape, notify this office.

PPQ FORM 526 (Reverse)