PPQ Form 564 Request for Additional Mailing Labels

Clear Form
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 number for this information collection is
0579-0049. The time required to complete this information collection is estimated to average .08 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.
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

REQUEST FOR ADDITIONAL
MAILING LABELS

OMB APPROVED
0579-0049
Exp.: XX/XXXX

INSTRUCTIONS: The enclosed green-and-yellow labels are to be used only for those
shipments which will be made by mail, (air mail, air parcel post, surface mail, or parcel
post). Please see paragraphs 12, 13, and 14 of circular Q.37-2 for details on
importations made by means other than by mail. Please use this form for requesting
additional mailing labels. NOTE: Shipments imported by mail must be accompanied by
USDA-PPQ approved label bearing permit no. (7 CFR 319.37).

FROM

TO

NAME
STREET ADDRESS

USDA, APHIS, PPQ
4700 RIVER ROAD, UNIT 136
RIVERDALE, MD 20737-1236

CITY AND STATE (include ZIP Code)

TELEPHONE NO. (include Area Code)

Please furnish ___________ labels bearing permit number ________________ for the importation of the following:

BOTANICAL NAME OF
PROPAGATING MATERIAL

DATE

SIGNATURE AND TITLE

PPQ FORM 564
MAY 2009

NUMBER OF SHIPMENTS
EXPECTED DURING NEXT
12 MONTH PERIOD

FROM
COUNTRIES OF ORIGIN

Previous editions obsolete.

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).