Gypsy Moth Identification Worksheet

OMB 0579-0104

The identification worksheet is needed to evaluate and control Gypsy Moth infestations from entering the United States.

The latest form for Gypsy Moth Identification Worksheet expires 2021-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form PPQ-391 Insect Collection Worksheet - State Form
Form PPQ Form 377 Gypsy Moth Checklist/Self Inspection - Individuals Form and Instruction
0104 2021 SS (20210921).docx Supporting Statement A
0104 2021 APHIS 79 (20210913).xlsx Supplementary Document
0104 2021 APHIS 71 (20210913).xlsx Supplementary Document
Moving Industry Notification of Homeowners - Business
Insect Collection Worksheet - State Form
Gypsy Moth Checklist/Self Inspection - Individuals Form and Instruction

All Historical Document Collections

202102-0579-005 Approved with change	Extension without change of a currently approved collection	2021-09-22
201712-0579-007 Approved with change	Revision of a currently approved collection	2017-12-27
201403-0579-002 Approved without change	Revision of a currently approved collection	2014-08-19
201010-0579-021 Approved without change	Extension without change of a currently approved collection	2011-07-06
200802-0579-004 Approved without change	Extension without change of a currently approved collection	2008-07-16
200505-0579-003 Approved without change	Revision of a currently approved collection	2005-05-12
200203-0579-005 Approved without change	Revision of a currently approved collection	2002-03-29
199809-0579-005 Approved without change	Revision of a currently approved collection	1998-09-21
199508-0579-002 Approved without change	Revision of a currently approved collection	1995-08-07
199209-0579-001 Approved without change	Revision of a currently approved collection	1992-09-14
199206-0579-001 Approved without change	New collection (Request for a new OMB Control Number)	1992-06-22

OMB Details

Federal Enterprise Architecture: Natural Resources - Agricultural Innovation and Services

Form PPQ-391

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.