According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to This report is authorized by law 

respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control numbers for this (7 U.S.C. 147a). While you are not information collection are 0579-0010 and 0104. The time required to complete this information collection is estimated to OMB APPROVED required to respond, your cooperation 

average .25 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and 0579-0010 and 0104 is needed to make an accurate record 

maintaining the data needed, and completing and reviewing the collection of information. of plant pest conditions. 

UNITED STATES DEPARTMENT OF AGRICULTURE Instructions: Type information requested. Block 1 – assign a number for each colle

ANIMAL AND PLANT HEALTH INSPECTION SERVICE your own numbering convention or use the following example by beginning with the y

by the collector’s initials and the collector’s number. Example: 14-JJD-001. 

SPECIMENS FOR DETERMINATION Pest Data Section – Complete Blocks 14, 15 and 16. Complete Items 17 and 18 if a 

1. COLLECTION NUMBER 2A. DATE - SUBMISSION 2.B. DATE - COLLECTION 3. SUBMITTING AGENC

MONTH DAY YEAR MONTH DAY YEAR State Cooperator 

 Other: 

ORIGIN 

4A. NAME OF SUBMITTER 4B. NAME OF COLLECTOR 6. TYPE OF PROPERTY (FARM, RE

5. ADDRESS OF SUBMITTER 

ITE INTERCEPTION S

7. NAME AND ADDRESS OP

SUBMITTER AND 

ZIP CITY UN

EMAIL ADDRESS OF SUBMITTER LATITUDE 

8. REASON FOR IDENTIFICATION (“X” all applicable items) 

A. 

OF PR

CO

Biological Control (Target Pest Name _____________________________) E. Export Certificat

PURPOSE 

Targeted Surve B. Damaging Crops/Plants F. ____________

C. Suspected Pest of Regulatory Concern (Explain in REMARKS) G. Smuggling Inter

D. Stored Product Pest H. Other (Explain i

9. IF PROMPT OR URGENT IDENTIFICATION IS REQUESTED, PLEASE PROVIDE A BRIEF EXPLANATION UNDER “REMARK

10. HOST INFORMATION 11. QUANTITY OF HOST 

NAME OF HOST (Scientific name and name of cultivar if appropriate) NUMBER OF ACRES/PLANTS 

tr

ATA 

ction using LOT NUMBER PRIORITY 

ear, followed 

i

y

_

n

S

URGENT 

PROMPT 

ap was used. ROUTINE 

Y 

 University APHIS PPQ 

SIDENCE, NURSERY. ETC.) 

ERTY OWNER 

TY STATE 

LONGITUDE 

on 

 (Pest Name 

____________________) 

diction/Trade Compliance (SITC) 

 REMARKS) 

”. 

Plant affected (insert figure and indicate) 

Number: 

HOST D

Percent: 

12. PLANT DISTRIBUTION 13. PLANT PARTS AFFECTED 

Leaves, Upper Surface Trunk/Bark Bulbs, Tubers, Corms Seeds Limited 

Leaves, Lower Surface Branches Buds 

Scattered 

Petiole Growing ps Ti Flowers 

Widespread Stem Roots Fruits or Nuts 

14. PEST DISTRIBUTION 15. INSECTS NEMATODES MOLLUSKS 

FEW 

PEST DATA 

NUMBER CAST LARVAE PUPAE ADULTS EGGS NYMPHS JUVS. CYSTS SUBMITTED SKINS COMMON 

ABUNDANT ALIVE 

EXTREME DEAD 

16. SAMPLING METHOD 17. TYPE OF TRAP AND LURE 18. TRAP NUMBER 

19. REMARKS METHOD 

MORPHOLOGY 

SYMPTOM 

CULTURE 

SEROLOGICAL 

PCR 

SEQUENCING 

20. TENTATIVE DETERMINATION DETERMINED BY POSITION AND AFFILIATION 

21. FINAL DETERMINATION AND NOTES (NOT FOR FIELD USE) METHOD 

MORPHOLOGY 

SYMPTOM 

CULTURE 

SEROLOGICAL 

PRINT NAME DISPOSITION OF SPECIMEN/SAMPLE PCR 

Retained for Transferred to: Returned yed SEQUENCING Destro Collection/Stored ________________ 

SIGNATURE DATE LAB CONFORMATION NUMBER DATE RECEIVED 

PPQ Form 391 Previous editions are obsolete. 

DEC 2017
INSTRUCTIONS 

Use PPQ Form 391, Specimens for Determination, for domestic collections (warehouse inspections, local and individual 

collecting, special survey programs, export certification). 

BLOCK INSTRUCTIONS 

1. Assign a number for each collection using your own numbering convention or use the 

following example by beginning with the year, followed by the collector’s initials and the 

collector’s number. 

1 In 2014, Brian K. Long collected his first specimen of the year for EXAMPLE determination. His first collection number is 14-BLK-001 

2. Enter the collection number 

2A-2B Enter dates 

3 Check block to indicate Agency submitting specimens for identification 

4A Enter name of submitter 

4B Enter name of collector 

5 Enter address of submitter 

6 Enter type of property specimen obtained from (farm, nursery, residence, etc.) 

7 Enter name and address of property owner 

8A-8H Check all appropriate blocks 

9 Leave Blank 

10 Enter scientific name of host, if possible 

11 Enter quantity of host and plants affected 

12 Check block to indicate distribution of plant 

13 Check appropriate blocks to indicate plant parts affected 

14 Check block to indicate pest distribution 

 Check appropriate block to indicate type of specimen 15  Enter number specimens submitted under appropriate column 

16 Enter sampling method 

17 Enter type of trap and lure 

18 Enter trap number 

19 Provide a brief explanation if Prompt or URGENT identification is requested 

20 Enter a tentative determination and who made it 

21 Leave blank 

Distribution of PPQ Form 391 

Distribute PPQ Form 391 as follows: 

1. Send Original along with the sample to your Area Identifier or for national confirmation. 

2. Retain and file a copy for your records. 

PPQ Form 391 Reverse