Gypsy Moth Checklist/Self Inspection - Individuals

Gypsy Moth Identification Worksheet

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0104 can be found here:

Documents and Forms

Document Name Document Type
Form PPQ Form 377 Gypsy Moth Checklist/Self Inspection - Individuals Form and Instruction
Screensots GM online Checklist.pdf www.aphis.usda.gov/proxy/http/feb.aphis.usda.gov/forms/before/moving/check/for/gypsy/moth Other-Online Checklist
PPQ Form 377 Gypsy Moth Checklist and Record of Your Self-Inspection PPQ 377 SEP 2018 (sec).pdf www.aphis.usda.gov/publications/plant_health/fsc-moving-check-gypsy-moth.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Gypsy Moth Checklist/Self Inspection - Individuals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 301.45-4(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PPQ Form 377	Gypsy Moth Checklist and Record of Your Self-Inspection	PPQ 377 SEP 2018 (sec).pdf	https://www.aphis.usda.gov/publications/plant_health/fsc-moving-check-gypsy-moth.pdf	Yes	No	Printable Only
Other-Online Checklist			Screensots GM online Checklist.pdf	https://www.aphis.usda.gov/proxy/http/feb.aphis.usda.gov/forms/before/moving/check/for/gypsy/moth	Yes	No	Fillable Printable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500,000	Number of Respondents for Small Entity: 2,450,000

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,000,000	4,600,000	400,000
Annual IC Time Burden (Hours)	2,707,500	2,490,900	216,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.