Form PPQ 10 PPQ 10 APHIS Pest Reporting Form

APHIS Pest Reporting and Asian Longhorned Beetle Program

PPQ 10 MAR 2013

Individuals and Households

OMB: 0579-0311

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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 unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0579-0311.  The time required to complete this information collection is estimated to average .083 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

0579–0311

EXP. DATE XX/XXXX

U.S. DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH

INSPECTION SERVICE (APHIS)


Plant Protection and Quarantine

Pest Reporting Form


Contact Information

1. First Name


2. last name

3. Phone number


4. Email

5. City


6. County

7. State

8. Zip Code


Location and Date of Sighting

9. Street address


10. City


11. County

12. State


13. Zip Code

14. Date of Sighting

15. Description of sighting location (i.e., nearby cross streets, physical landmarks, other features to help pinpoint the location of the suspected pest or disease), AND GPS COORDINATES OF SIGHTING (optional)




Location and Date of Search

16. Street address


17. City


18. County

19. State


20. Zip Code

21. Date of Search

22. Description of search location (i.e., homeowner’s property, public park, trees along street, etc.)





23. Types of plant(s) or tree(s) inspected, if known




24. Number of plant(s) or tree(s) inspected





Signs or Symptoms of Pest or Disease Damage Observed

25. Did you observe any signs or symptoms of pest or disease damage?

Yes No

26. Description of damage observed





27. Upload photo (submit a photo of what you observed)




28. Did you collect a specimen?

Yes No

If you would like to report a possible sighting of a plant pest or disease, please complete this form and send it to the USDA APHIS State Plant Health Director in your State. For a complete contact list, please visit: http://www.aphis.usda.gov/services/report_pest_disease/report_pest_disease.shtml.


PPQ Form 10

MAR 2013

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
Authorsmharris
File Modified0000-00-00
File Created2021-01-15

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