Form VS 4-52A VS 4-52A Report of Back Tags Applied

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0047. The time required to complete this information collection is estimated to average .0830 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved 0579-0047 Exp. 00/00/0000

united states department of agriculture animal and plant health inspection service veterinary services

report of back tags applied

where applied – name and address

1. ranch or farm

for office use only blood test results

2. public stockyards

3. other livestock markets

4. slaughter establishments

prefix number

Check one

tags applied by

1. market employee

(Yellow Tag)

(White Tag)

2. regulatory personnel

3. contractor

4. other (Specify)

tag number

Date tags applied

sales tag no.

brand and location

Herd owner’s name

Address

county

N

s

r

VS FORM 4-52A

APR 2009