Form ST-472 Nat'l Ctr for Genetic Resources Preservation Deposit For

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Form ST-472

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OMB NO. 0581-0055
Expiration Date: 01/31/2022

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
SCIENCE AND TECHNOLOGY - PLANT VARIETY PROTECTION OFFICE

VOUCHER SAMPLE FORM - SEED
The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act (PRA) of 1995.
OMB Collection #0581-0055

INSTRUCTIONS
Instructions: 1. Fill in all Sections; 2. Include Form as attachment to Notification Email to NLGRP PVP Coordinator; 3. Enclose
printed copy with voucher sample. (***Please see attached appendix for procedural information***)
ATTN: PVP Coordinator
USDA-ARS, National Laboratory for Genetic Resources Preservation
1111 South Mason Street, Fort Collins, CO 80521-4500
Telephone: 970-492-7538 | Email: [email protected]
More Information: https://www.ars.usda.gov/plains-area/fort-collins-co/center-for-agricultural-resourcesresearch/paagrpru/docs/plants/pages/deposit-germplasm/
FOR INTERNAL USE ONLY
NSSL SERIAL NUMBER:

PI NUMBER:

SEED SAMPLE DEPOSIT:
Percent Viable:
Date Received:
VARIETY INFORMATION
2. COMMON NAME

1. PVP NUMBER

3. SCIENTIFIC NAME

4. CULTIVAR / VARIETY NAME (Put around the name to denote a temporary designation)

5. PARENT NAMES: (Fill out only for F1 hybrid cultivars, leave blank otherwise)

6. DOES THE VARIETY CONTAIN ANY BIOTECHNOLOGY EVENTS? *
YES

NO

*A biotechnology event is defined as a single insertion of a nucleic acid construct into a specific site in a plant’s chromosome; that is
regulated under the U.S. Coordinated Framework for the Regulation of Biotechnology.
7. PATENTS: Is the variety protected under any patents?
YES

NO

If YES, provide patent application number / patent number:

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Form ST-472

OMB NO. 0581-0055
Expiration Date: 01/31/2022

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
SCIENCE AND TECHNOLOGY - PLANT VARIETY PROTECTION OFFICE

VOUCHER SAMPLE FORM - SEED
The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act (PRA) of 1995.
OMB Collection #0581-0055

APPLICANT INFORMATION
9. REPRESENTATIVE NAME:

8. OWNER NAME:

10. OWNER ADDRESS:

11. CITY:

12. STATE:

15. PHONE NUMBER:

13. ZIP CODE:

14. COUNTRY:

16. FAX NUMBER:

17. EMAIL:

SUPPLIER INFORMATION
SUPPLIER of seed or vegetatively propagated material, IF DIFFERENT FROM APPLICANT
18. SUPPLIER NAME:

19. SUPPLIER ADDRESS:

20. CITY:

24. PHONE NUMBER:

21. STATE:

22. ZIP CODE:

25. FAX NUMBER:

26. EMAIL:

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23. COUNTRY:

Form ST-472

OMB NO. 0581-0055
Expiration Date: 01/31/2022

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
SCIENCE AND TECHNOLOGY – PLANT VARIETY PROTECTION OFFICE

VOUCHER SAMPLE FORM – SEED
APPENDIX – PVP Seed Voucher Sample Submission Protocols
The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act (PRA) of 1995.
OMB Collection #0581-0055

A complete listing of the rules and regulations associated with deposit of PVP voucher specimens can be found in Section
97.7 of the PVP Act Regulations and Rules of Practice. A pdf copy of the PVP Act and Regulations can be downloaded from the
PVP website: www.ams.usda.gov/pvpo.
NATIONAL LABORATORY FOR GENETIC RESOURCES PRESERVATION
PVP VOUCHER SEED SUBMISSION PROTOCOL
(Non-U.S. depositors: Please read shipping instructions on next page)
WARNING: Do not send voucher specimens until the PVP application has been filed and you have received the PVP application
number from the PVP Office.
NOTE: These protocols are for seed samples, not for tissue cultures.
1.

Voucher sample should be deposited at the NLGRP within three months of filing the application or prior to PVP Certificate
being issued, whichever comes first.

2.

Voucher sample should be sent by commercial carrier (i.e., FEDEX, UPS, DHL, etc.) and be in transit for the shortest time
(i.e., overnight shipment preferred).

3.

Depositor must notify NLGRP PVP Coordinator of shipment and provide tracking information. Send notification to:
[email protected] and [email protected]. Please include PVP number in subject line.

4.

Attach PVP SEED VOUCHER DEPOSIT FORM to shipping notification email AND enclose a copy of printed form with
material.

5.

Voucher sample: 3000 untreated seeds with ≥ 85 % viability in sealed, moisture permeable bag. First generation hybrid
cultivars require 3000 F1 seed and 3000 seed of each parent. Clearly label seed packets to identify hybrid and parents
(male and female). Cultivars with cytoplasmic male sterility require 3000 seeds of CMS cultivar and 3000 seeds of
maintainer/restorer lines. Clearly label seed packets to identify cultivar and maintainer/restorer lines.
(LIST CONTINUED BELOW)

SAMPLE EMAIL:
FROM: Supplier
TO: [email protected] ; [email protected]
CC: Applicant, PVP examiner
SUBJECT: PVP # XXXXXXXXX, PVP # XXXXXXXXX, etc.
Today Company X shipped the PVP seed deposits for the following varieties:
Crop 1 -Variety 1, Variety 2, Variety 3
Crop 2 -Variety 7, variety 8
The completed NLGRP forms are attached. Hard copies of the forms are included in the seed shipment.
Please notify the supplier, applicant, and PVP office when seed arrives or if seed is not received within two weeks after email
notification of shipping. Please keep good communication between NLGRP, PVP Office, applicant and supplier. It is important in
order for the customer to know the status of the application and also for germplasm security.
Let me know if you have any questions regarding this shipment.

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Form ST-472

OMB NO. 0581-0055
Expiration Date: 01/31/2022

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
SCIENCE AND TECHNOLOGY – PLANT VARIETY PROTECTION OFFICE

VOUCHER SAMPLE FORM – SEED
APPENDIX – PVP Seed Voucher Sample Submission Protocols
The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act (PRA) of 1995.
OMB Collection #0581-0055

SHIPPING INFORMATION
Domestic (U.S.) Sources: Seed samples from within the U.S. should be sent to NLGRP at the following address via
commercial carriers (i.e., FedEx, UPS, etc.) rather than the U.S. Postal Service.
USDA-ARS-NLGRP
Attn: PVP Coordinator
1111 South Mason St.
Fort Collins, CO 80521
Non-U.S. Depositors:
a.

Email [email protected], in advance of shipping to request instructions for importing material into the
United States. Include INTERNATIONAL SHIPMENT in subject line. Please let us know if you are importing seed or potato
plantlets, and the country where the material was field grown.

b.

NLGRP will provide depositor with an Import Instruction Letter and appropriate permit/shipping label (if applicable). The
Import Instruction Letter instructs how to import material in accordance with USDA Animal and Plant Health Inspection
Service (APHIS) regulations. Please follow all instructions carefully. Material may be destroyed or returned if
conditions and regulations are not met.

c.

Information on specific import requirements can be found in the APHIS Plants for Planting Manual and/or APHIS
Agricultural Commodity Import Requirements Search Tool
(https://www.aphis.usda.gov/aphis/ourfocus/planthealth/complete-list-of-electronic-manuals).

Burden Statement 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 0581-0055. The time required to complete this information collection is estimated to average .5 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.
USDA’s Nondiscrimination Statement In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil
rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering
USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including
gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance
program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by
USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. Persons with
disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American
Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or
contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in
languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint
Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter
addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form,
call (866) 632-9992. Submit your completed form or letter to USDA by: 1) mail: U.S. Department of Agriculture Office of the Assistant
Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; 2) fax: (202) 690-7442; or 3) email:
[email protected]. USDA is an equal opportunity provider, employer, and lender.

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