Vs 5-29A Scrapie Test Record - Continuation Sheet

Accordingtotothe
thePaperwork
PaperworkReduction
Reduction
Act
1995,
persons
required
to respond
a collection
of information
unless
it displays
valid control
OMB control
number.
The
valid
OMBnumber
control for
number
for this
According
Act
of of
1995,
no no
persons
areare
required
to respond
to a to
collection
of information
unless
it displays
a validaOMB
number.
The valid
OMB
control
this information
information
collection is The
0579-0101.
The time
requiredthis
to information
complete this
information
collection
estimated
to average
.3 hours
per response,
the time
for reviewing
instructions,
existinggathering
data
collection
is 0579-0101.
time required
to complete
collection
is estimated
to is
average
2 hours
per response,
including
the timeincluding
for reviewing
instructions,
searching
existingsearch
data sources,
sources,
gathering
and
maintaining
the
data
needed,
and
completing
and
reviewing
the
collection
of
information.
and maintaining the data needed, and completing and reviewing the collection of information.
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

FLOCK OWNER'S NAME - LAST

Specimen #

FIRST

Official ID Number

NOTE: Sample numbers on specimens must be the same as
listed on this form.
Remarks:

VS FORM 5-29A
Sep 2007

INITIAL

__ of __

Designation
(pos, sus,
exp, me, n/a)

FORM
APPROVED
OMB NO.
0579-0101

VETERINARIAN

DATE
COLLECTED

Other ID Numbers

PAGE NO.

FLOCK ID

SCRAPIE TEST RECORD - CONTINUATION SHEET
Complete all entries on VS Form 5-29 before using this form.

Age

Sex
(f,m,cm
)

Breed
(if unknown,

3rd Eyelid Info

face color)
L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

Circle if the 3rd eyelid tissue came from the Left or Right
eye. Circle if the lymphoid tissue was Seen or Unseen

COPY DESGINATIONS

PART 1 - OFFICE
PART 2 - OFFICE
PART 3 - OWNER
PART 4 - VETERINARIAN
PART 5 - ASSIGNMENT

PLACE ON HARD SURFACE AND WRITE FIRMLY

"USE TYPEWRITER OR PRINT CLEARLY - PRESS HARD - YOU ARE MAKING 5 COPIES"