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 0579-0311. The time required to complete this
information collection is estimated to average .083 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.
OMB
APPROVED
0579–0311
EXP.
DATE XX/XXXX
U.S.
DEPARTMENT OF AGRICULTURE
ANIMAL
AND PLANT HEALTH
INSPECTION
SERVICE (APHIS)
Plant
Protection and Quarantine
Pest
Reporting Form
Contact
Information
1.
First Name
2.
last name
3.
Phone number
4.
Email
5.
City
6.
County
7.
State
8.
Zip
Code
Location
and Date of Sighting
9.
Street address
10.
City
11.
County
12.
State
13.
Zip Code
14.
Date of Sighting
15.
Description of sighting location (i.e.,
nearby cross streets, physical landmarks, other features to help
pinpoint the location of the suspected pest or disease), AND
GPS COORDINATES OF SIGHTING (optional)
Location
and Date of Search
16.
Street address
17.
City
18.
County
19.
State
20.
Zip Code
21.
Date of Search
22.
Description of search location (i.e.,
homeowner’s property, public park, trees along street,
etc.)
23.
Types of plant(s) or tree(s) inspected, if known
24.
Number of plant(s) or tree(s) inspected
Signs
or Symptoms of Pest or Disease Damage Observed
25.
Did you observe any signs or symptoms of pest or disease damage?
Yes
No
26.
Description of damage observed
27.
Upload photo (submit
a photo of what you observed)