Form PPQ 391 PPQ 391 Specimens for Determinaton

This report is authorized by law (7 U.S.C. 147a). While you are not required to respond
your cooperation is needed to make an accurate record of plant pest conditions.

See reverse for additional OMB information.

SPECIMENS FOR DETERMINATION
1. COLLECTION NUMBER

2. DATE
MO

PRIORITY

3. SUBMITTING AGENCY
DA

YR
State
Cooperator

PPQ

Other

5. TYPE OF PROPERTY (Farm, Feedmill, Nursery, etc.)
INTERCEPTION SITE

4. NAME OF SENDER
SENDER AND ORIGIN

FOR IIBIII USE
LOT NO.

Instructions: Type or print information requested. Press hard and print legibly
when handwritten. Item 1 - assign number for each collection beginning with
year, followed by collector’s initials and collector’s number. Example (collector,
John J. Dingle): 83-JJD-001.
Pest Data Section – Complete Items 14, 15 and 16 or 19 or 20 and 21 as
applicable. Complete Items 17 and 18 if a trap was used.

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

OMB APPROVED 0579-0010
EXP. XX/XXXX

6. ADDRESS OF SENDER

ZIP

7. NAME AND ADDRESS OF PROPERTY OR OWNER

COUNTRY/
COUNTY

PURPOSE

8. REASON FOR IDENTIFICATION (“x” ALL Applicable Items)

A.

Biological Control (Target Pest Name

E.

Livestock, Domestic Animal Pest

B.

Damaging Crops/Plants

)

F.

Possible Immigrant (Explain in REMARKS)

C.

Suspected Pest of Regulatory Concern (Explain in REMARKS)

G.

Survey (Explain in REMARKS)

D.

Stored Product Pest

H.

Other (Explain in REMARKS)

9. IF PROMPT OR URGENT IDENTIFICATION IS REQUESTED, PLEASE PROVIDE A BRIEF EXPLANATION UNDER “REMARKS”.

HOST DATA

10. HOST INFORMATION
NAME OF HOST (Scientific name when possible)

Percent):
12. PLANT DISTRIBUTION

13. PLANT PARTS AFFECTED

LIMITED
SCATTERED
WIDESPREAD

Leaves, Upper Surface

Trunk/Bark

Bulbs, Tubers, Corms

Leaves, Lower Surface

Branches

Buds

Petiole

Growing Tips

Flowers

Stem

Roots

Fruits or Nuts

15.

14. PEST DISTRIBUTION

PEST DATA

11. QUANTITY OF HOST
PLANTS AFFECTED (Insert figure and
Number
indicate

NUMBER OF
ACRES/PLANTS

NUMBER
SUBMITTED

FEW
COMMON
ABUNDANT
EXTREME

INSECTS

LARVAE

NEMATODES

PUPAE

ADULTS

CAST SKINS

Seeds

MOLLUSKS
EGGS

NYMPHS

JUVS.

ALIVE
DEAD

16. SAMPLING METHOD

17. TYPE OF TRAP AND LURE

18. TRAP NUMBER

19. PLANT PATHOLOGY – PLANT SYMPTOMS (“X” one and describe symptoms)

ISOLATED

GENERAL

20. WEED DENSITY

FEW

21. WEED GROWTH STAGE

SPOTTY

GENERAL

SEEDLING

VEGETATIVE

FLOWERING/FRUITING

MATURE

22. REMARKS

23. TENTATIVE DETERMINATION
24. DETERMINATION AND NOTES (Not for Field Use)

FOR IIBIII USE
DATE RECEIVED

NO.
LABEL
SORTED
PREPARED
DATE ACCEPTED
SIGNATURE

PPQ FORM 391
(AUG 02)

DATE

Previous editions are obsolete.

RR

CYSTS

OMB Information
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0579-0010. The time
required to complete this information collection is estimated to average .25 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.

Instructions
Use PPQ Form 391, Specimens for Determination, for domestic collections (warehouse inspections,
local and individual collecting, special survey programs, export certification).
BLOCK

INSTRUCTIONS
1. Assign a number for each collection beginning the year, followed by the
collector’s initials and collector’s number

1

EXAMPLE

In 2001, Brian K. Long collected his first specimen for determination
of the year. His first collection number is 01-BLK-001

2. Enter the collection number
2

Enter date

3

Check block to indicate Agency submitting specimens for identification

4

Enter name of sender

5

Enter type of property specimen obtained from (farm, nursery, feedmill, etc.)

6

Enter address

7

Enter name and address of property owner

8A-8L

Check all appropriate blocks

9

Leave Blank

10

Enter scientific name of host, if possible

11

Enter quantity of host and plants affected

12

Check block to indicate distribution of plant

13

Check appropriate blocks to indicate plant parts affected

14

Check block to indicate pest distribution

15

•
•

16

Enter sampling method

17

Enter type of trap and lure

18

Enter trap number

19

Enter X in block to indicate isolated or general plant symptoms

20

Enter X in appropriate block for weed density

21

Enter X in appropriate block for weed growth stage

22

Provide a brief explanation if Prompt or URGENT identification is requested

23

Enter a tentative determination if you made one

24

Leave blank

Check appropriate block to indicate type of specimen
Enter number specimens submitted under appropriate column