PPQ 523 Emergency Action Notification

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, 0579-0437, and
others. The time required to complete this information collection is estimated to average .033 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

EMERGENCY ACTION NOTIFICATION
3. NAME AND QUANTITY OF ARTICLE(S)

OMB Approved
0579-0049, 0437, et al

SERIAL NUMBER
1. PPQ LOCATION

2. DATE ISSUED

4. LOCATION OF ARTICLES

5. DESTINATION OF ARTICLES
6. SHIPPER

7. NAME OF CARRIER
8. SHIPMENT ID NUMBER(S)

9. OWNER/CONSIGNEE OF ARTICLES
9a. NAME

10. PORT OF LADING

9b. ADDRESS

12. ID OF PEST(S), NOXIOUS WEEDS, OR ARTICLE(S)

9c. PHONE NUMBER

9d. FAX NUMBER

11. DATE OF ARRIVAL

12a. PEST ID NUMBER

12b. DATE INTERCEPTED

13. COUNTRY OF ORIGIN

14. GROWER NUMBER

15. FOREIGN CERTIFICATE NUMBER

9e. TAX IDENTIFICATION NUMBER (TIN)

15a. PLACE ISSUED

15b. DATE

Under Sections 411, 412, and 414 of the Plant Protection Act (7 U.S.C. 7711, 7712, and 7714) and Sections 10404 through 10407 of the Animal Health
Protection Act (7 U.S.C. 8303 through 8306), you are hereby notified, as owner or agent of the owner of said carrier, premises, and/or articles, to apply
remedial measures for the pest(s), noxious weeds, and/or article(s) specified in Item 12, in a manner satisfactory to and under the supervision of an Agriculture
Officer. Remedial measures shall be in accordance with the action specified in Item 16 and shall be completed within the time specified in Item 17.
AFTER RECEIPT OF THIS NOTIFICATION, ARTICLES AND/OR CARRIERS HEREIN DESIGNATED MUST NOT BE MOVED EXCEPT AS DIRECTED BY
AN AGRICULTURE OFFICER. THE LOCAL OFFICER MAY BE CONTACTED AT:
16. ACTION REQUIRED
TREATMENT
RE-EXPORTATION
DESTRUCTION
OTHER

Should the owner or owner's agent fail to comply with this order within the time specified below, USDA is authorized to recover from the owner or
agent cost of any care, handling, application of remedial measures, disposal, or other action incurred in connection with the remedial action,
destruction, or removal.
17. AFTER RECEIPT OF THIS NOTIFICATION, COMPLETE SPECIFIED ACTION
WITHIN (Specify Number of Hours or Number of Days):

18. SIGNATURE OF OFFICER:

19. ACKNOWLEDGMENT OF RECEIPT OF EMERGENCY ACTION NOTIFICATION
I hereby acknowledge receipt of the foregoing notification.
SIGNATURE AND TITLE

ACTION TAKEN

DATE AND TIME:
20. REVOCATION OF NOTIFICATION

SIGNATURE OF OFFICER
PPQ FORM 523
SEP 2018

DATE:
(Previous editions are obsolete.)