VS 5-22 Application for the Scrapie Flock Certification Program

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

FORM APPROVED
OMB NO. 0579-0101

APPLICATION FOR THE SCRAPIE FLOCK CERTIFICATION PROGRAM
1. OWNER'S NAME AND ADDRESS

Telephone Number

(

2. LOCATION(S) OF FLOCK(S)

)

GPS NO.
4. FLOCK ID NUMBER

3. NUMBER OF ANIMALS IN FLOCK

I ______________________________________________ agree to abide by the provisions of the Scrapie Flock Certification
Program for an export monitored flock/complete monitored flock /a selective monitored flock (circle one) including the following:
A. To immediately report scrapie suspect animals, animals suspected of other neurologic and chronic debilitating (prolonged wasting) illnesses or
animals over 14 months of age which are found dead on the farm to the designated State Animal Health Official Veterinary Services representative, or
an accredited veterinarian, and to ensure that proper tissue samples are collected and submitted for diagnostic purposes. Such animals shall not be used
for breeding or disposed of without the prior approval of a State or APHIS representative.
B. To officially identify all animals / all male animals (circle one) 1 year of age or over within a flock. Officially identify all acquired animals / male
animals (circle one) prior to commingling with the flock. All animals / all male animals (circle one) less than 1 year of age will be officially identified
when a change of ownership occurs, with the exception of those moving within slaughter channels. The official identification will be a program
approved identification, which may be applied by the flock owner. A secondary form of identification may be maintained at the owner's discretion.
C. To maintain records in accordance with the specific provisions of the Program. Records must be kept for a minimum of 7 years after an animal dies
or has otherwise been removed from the flock.
D. To allow breed associations and registries, livestock markets, and packers to disclose records to Veterinary Services representative or State Animal
Health Officials. These records will be used to trace a source of expsoure and other exposed animals.
E. To notify the State Scrapie Certification Board and or the Veterinary Services Area Office about acquisitions from or commingling with
nonparticipating flocks or flocks of lower status within 30 days after the animal enters or commingles with the flock.
F. To make animals and records available for inspection by Veterinary Services representatives, State Animal Health Officials and State Scrapie
Certification Board representatives, given reasonable prior notice. To have the necessary facilities and personnel available to assist in inspecting the
identification of each animal and the records. To schedule a flock inspection every 11 - 13 months, based on the last inspection date.
G. Tissues from scrapie suspect animals, animals suspected of other neurologic and chronic debilitating (prolonged wasting) illnesses, and any other
animal required by the program standards will be submitted to an official laboratory in accordance with part IV and appendix 1, Scrapie Flock
Certification Program Standards. Other tissues will be submitted in accordance with the requirements or at the request of the State Scrapie Certification
Board.
H. A list of the animals in the flock and their official identification is attached.
5. REMARKS

6. STATE REPRESENTATIVE'S SIGNATURE

10. VETERINARY SERVICES REPRESENTATIVE'S SIGNATURE

VS FORM 5-22
JUN 2007

7. DATE

8. OWNER'S SIGNATURE

9. DATE

11. DATE

12. STATE SCRAPIE CERTIFICATION BOARD
REPRESENTATIVE'S SIGNATURE

13. DATE

(Previous editions are obsolete.)