7-5 Accelerated Pseudorabies Eradication Program Contact Dat

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
number. The valid OMB number for this information collection is 0579-0137. The time required to complete this collection of information is
estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the form.

FORM APPROVED
OMB NUMBER
0579-0137

Accelerated Pseudorabies Eradication Program
Contact Date Form
PERSON'S NAME

DATE OF CONTACT

OWNER'S NAME (if different)

PREMISES NAME (if different)

OWNER'S ADDRESS (City, State, Zip)

COUNTY

TOWNSHIP

SECTION

TIME

OWNER'S PHONE NUMBER

PREMISES IDENTIFICATION NUMBER:
PRV STATUS OF THIS HERD:

STATUS ISSUE DATE:
ESTIMATED HERD POPULATION

# BREEDING SWINE

PERSON RECEIVING CALL
VS FORM 7-5
FEB 2002

#LESS THAN 200 LBS.

#GREATER THAN 200 LBS.