7001A U.S. Interstate and International Certificate of Health

No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by USDA regulation shall be delivered to any intermediate handler or carrier for
transportation in commerce, unless accomplanied by a health certificate executed and issues by a licensed veterinarian (7 USC 21.43.9 CFR, Subchapter A, Part 2).

(See reverse fir additional OMB statement.)

1. CERTIFICATE NUMBER
(Insert certificate no. from page 1)

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE
OF HEALTH EXAMINATION FOR SMALL ANIMALS

2. PAGE

Continuation Sheet

..... of .....

3. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER/CONSIGNOR

4. NAME, ADDRESS, AND TELEPHONE NUMBER OF CONSIGNEE

5. ANIMAL IDENTIFICATION (To be completed by owner/consignor)

6. VACCINATION HISTORY (To be completed by veterinarian)

COMPLETE USDA TAG,
COLLAR AND/OR TATTOO
NUMBER

BREED - COMMON
OR SCIENTIFIC
NAME

AGE

SEX

COLOR OR
DISTINCTIVE MARKS

(11)
(12)
(13)
(14)

(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
(27)
(28)
(29)
(30)
(31)
APHIS FORM 7001A (SEP 93)

(Replaces VS Form 18-1A, which may be used).

FORM APPROVED
OMB NO. 0579-0036, 0579-0247,
and 0579-0254

RABIES
Killed Virus

Live Virus

Date

Product

attact original signature
rebies certificate here
OTHER VACCINATIONS,
TESTS OR TREATMENT

D-H-L
Date

Product

Date

Type/Result

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control numbers for this information collection are 0579-0036, and 0579-0247. The time required to complete these information
collections are estimated to average .25 hours per response and 5 hours per recordkeeper for 0579-0036; .25 hours per response and 20 hours per
recordkeeper for 0579- 0247. These times include time for reviewing instructions, seraching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.

APHIS FORM 7001A (REVERSE)