Form VS-16-4 Health Certificate Export Certificate Animal Products

According to the Paperwork Reduction Act of 1985, no persons are required to respond to a collection of information unless it displays a valid OMB number. The
valid OMB control number for this information collection is 0579-0256. The time to complete this collection of information is estimated to average .5 hours per
response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the form.

FOR OFFICIAL USE ONLY

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

HEALTH CERTIFICATE
EXPORT CERTIFICATE

ANIMAL PRODUCTS

OMB NUMBER
0579-0256

PORT

FOR OFFICIAL USE ONLY

DATE
AND NO.

This certificate is for Veterinary purposes only. It is valid for 30 days after the date of signature (in the case of transport by ship or rail, the time
is prolonged by the time of the voyage).
This is to certify that rinderpest, foot-and-mouth disease, classical swine fever, swine vesicular disease, African swine fever, and contagious bovine
pleuropneumonia do not exist in the United States of America.
ADDITIONAL DECLARATION

(SIGNATURE OF ENDORSING OFFICIAL)

(TYPED NAME)

DESCRIPTION OF THE CONSIGNMENT
NAME AND ADDRESS OF EXPORTER

(TITLE OF ENDORSING OFFICIAL)

NAME AND ADDRESS OF CONSIGNEE

PRODUCT (quantity, unit of measure, and kind)

IDENTIFICATION

VS FORM 16-4
(MAR 2004)

CONVEYANCE