Form PPQ Form 519 PPQ Form 519 Compliance Agreement

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 numbers for this information collection are 0579-0015, 0049, 0054, 0088,
0124, 0155, 0187, 0310, 0317, 0322, 0331, 0337, 0346, 0363, 0383, and 0450. The time required to complete this information collection is
estimated to average .50 to 1.25 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
1. NAME AND MAILING ADDRESS OF PERSON OR FIRM

OMB APPROVED
0579-0015, 0049, 0054, 0088,
0124, 0155, 0187, 0310, 0317,
0322, 0331, 0337, 0346, 0363,
0383, and 0450

COMPLIANCE AGREEMENT
2. LOCATION

3. REGULATED ARTICLE(S)

4. APPLICABLE FEDERAL QUARANTINE(S) OR REGULATIONS

5. I / WE AGREE TO THE FOLLOWING:

6. SIGNATURE

7. TITLE

8. DATE SIGNED

9. AGREEMENT NUMBER

The affixing of the signatures below will validate this agreement which shall remain in
effect until canceled, but may be revised as necessary or revoked for noncompliance.
11. PPQ/CBP OFFICIAL (NAME AND TITLE)

12. ADDRESS

13. SIGNATURE

14. U.S. GOVERNMENT/STATE AGENCY OFFICIAL (NAME AND TITLE)

15. ADDRESS

16. SIGNATURE

PPQ FORM 519
SEP 2012

All previous editions are obsolete.

10. DATE OF AGREEMENT