PPQ 250 Aircraft Clearance or Safeguard Order

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 0579-0055. The time required to complete this information collection is estimated to average 5 minutes 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

1. AIRCRAFT NO.

2. TRIP/FLIGHT NO.

3. NAME OF CARRIER

5. PLACE OF DEPARTURE (U.S.)

4. FOREIGN ORIGIN (When applicable)

AIRCRAFT CLEARANCE
OR
SAFEGUARD ORDER

OMB APPROVED
0579-0055
EXP: XX/XXXX

6. DESTINATION AIRPORT OR AIR BASE (U.S.)

THE ABOVE AIRCRAFT HAS BEEN INSPECTED AND 7.

COMPLETELY CLEARED (Including all baggage, personal effects,
stores, garbage, and cargo.)

8.

PARTIALLY CLEARED (Exceptions and safeguard conditions noted in
item 11 below.)

9. SIGNATURE OF PLANT PROTECTION AND QUARANTINE OFFICER

10. DATE

14. FINAL DISPOSITION ACTION

11. EXCEPTIONS AND SAFEGUARD CONDITIONS

15. SIGNATURE OF PLANT PROTECTION AND
QUARANTINE OFFICER

16. DATE

AFTER FINAL DISPOSITION ACTION RETURN TO:
17. NAME AND ADDRESS OF ORIGINATING OFFICE
I agree to see the conditions in item 11 are carried out.
12. SIGNATURE OF AIRCRAFT COMMANDER

PPQ FORM 250
(FEB 2007)

13. DATE

(Previous editions may be used)