VS 17-129 Application for Import or In Transit Permit

Viral Hemorrhagic Septicemia (VHS); Interstate Movement and Import Restrictions on Certain Live Fish

vs17-129

Business

OMB: 0579-0340

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No animals, animal semen, animal embryos, birds,
poultry, or hatching eggs may be imported unless a
completed application has been received (9 CFR 92
and CFR 93.)

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 0579-0040,
and 0579-XXXX. The time required to complete this information collection is estimated to average 2 hours per response for
0579-0040, and .16 hours per response for 0579-XXXX, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completingand reviewing the collection of information.

FORM APPROVED OMB NO. 0579-0040,XXXX

1. NAME AND ADDRESS OF SHIPPER IN COUNTRY OF ORIGIN

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

APPLICATION FOR IMPORT OR IN TRANSIT PERMIT
(Animals, Animal Semen, Animal Embryos, Birds, Poultry, or Hatching Eggs)
INSTRUCTIONS TO IMPORTER: Complete and submit one copy to the Veterinary Services,
APHIS, U.S. Department of Agriculture, 4700 River Road, Riverdale, MD 20737. Prepare a
separate application for each shipment.
2. NAME AND ADDRESS OF IMPORTER (Include Area Code)

3. PORT OF EMBARKATION (From Canada show only for ocean vessel
or airplane shipments)

4. COUNTRY FROM WHICH SHIPPED

5. MODE OF TRANSPORTATION (Name of Airline or Vessel, flight no.)
TELEPHONE NUMBER (Include Area Code)

6. ANIMALS, ANIMAL SEMEN, ANIMAL EMBRYOS, BIRDS, POULTRY, OR HATCHING EGGS
A.

NO.

B.

BREED

C.

SPECIES

D.

DESCRIPTION
(Sex, Age, Registered Name and No., Tattoo, Tag No., other Markings)

6E. PURPOSE OF IMPORTATION

7. ROUTE OF TRAVEL INCLUDING ALL CARRIER STOPS ENROUTE (From Canada show route of travel only for ocean vessel or airplane shipment)

8. PROPOSED SHIPPING DATE (From Canada show only for ocean
vessel or airplane shipment)

9. PROPOSED ARRIVAL DATE

11. NAME AND MAILING ADDRESS OF PERSON TO WHOM DELIVERY WILL BE
(After quarantine, when required) (Include Zip Code)
MADE

10. UNITED STATES PORT OF ENTRY

12. WHERE DELIVERY WILL BE MADE IN U.S. (After quarantine, when
required) (Location of place)

TELEPHONE NUMBER (Include Area Code)

13. REMARKS

14. SIGNATURE OF IMPORTER

VS FORM 17-129 (DEC 2002) Previous edition may be used.

15. DATE SIGNED


File Typeapplication/pdf
File TitleInForms - vs17-129.wpf
Authorkhbrown
File Modified2008-07-09
File Created2006-09-07

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