RECORD OF SELF-INSPECTION FOR SPONGY MOTH | Animal and Plant Health Inspection Service

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Confirmation
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Instructions: Carefully inspect all of your outdoor household articles for spongy moth egg masses and other life stages. Remove and destroy any egg masses or other life stages you find, and then complete this form to self-certify that your outdoor household items are free of spongy moth. Visit Your Move Spongy Moth Free Website for more information.

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By typing my name below, I agree that I am legally signing this document and affirming that I have inspected all outdoor household articles for all life stages of spongy moth in accordance with the procedures on this form, as required by Title 7, Code of Federal Regulations, part 301.45-4(a).

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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
0579-0104

EXP. DATE
08/31/2026