See Notice/Instructions on Reverse See reverse for additional OMB statement OMB Approved 0579-0047
U.S. DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES
Animals removed from infected herd
Supplemental to VS Form 4-108 |
INSTRUCTIONS: List all animals (include feeder heifers and slaughtered cows and bulls but exclude reactors) sold or otherwise removed from the herd within the last two years, or since infection was introduced. Obtain all supporting documents. |
1. NAME OF HERD OWNER |
2. Document Number
|
|||||||||||
3. COUNTY |
4. HERD NO. |
5.
PAGE OF PAGES |
||||||||||||
6. LIST of animals sold or otherwise removed from the herd |
||||||||||||||
Buyer or recipient |
SALES |
IDENTIFICATION |
Sex |
Age when Sold |
Breed |
Vac. Status |
Disposition |
Verified (see codes) |
REMARKS (Stage of pregnancy, etc.) |
Brucellosis Status
1 – Untested 2 – Tested Neg. |
||||
NAME AND ADDRESS |
Date |
No. of Animals |
Tag No’s |
OTHER ID (Brands, Tattoos, etc.) |
||||||||||
A |
B |
C |
D |
E |
F |
G |
H |
I |
J |
K |
L |
M |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|||||||||||
7. Assignments made to contact recipient herds
Yes No |
8. signature of VMO |
CODE |
9. DATE SIGNED |
|||||||||||
|
VS FORM 4-108B Previous edition may be used
APR 2009
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 4 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.
_________________________________________________________________________________________________________________________
NOTICE TO HERD OWNERS
Herd Owners (Managers or Agents) of herds of brucellosis affected livestock must be advised that information is given voluntarily to assist in the elimination of brucellosis from the livestock population. Cooperation of all affected herd owners (Managers or Agents) is needed to complete a thorough epidemiologic investigation to identify the source of the disease, the method of spread and the possible dissemination to new herds. The authorities under which the brucellosis program is conducted are contained in 21 U.S.C. 111, 112, 114, 114a, 114a-1, 115, 120, 121, 125, and 134a-f and Title 9, Code of Federal Regulations, Parts 51 and 78.
INSTRUCTIONS
The purpose of this form is to record information of epidemiologic importance for each potentially brucella exposed animal removed from this herd. This information facilitates tracing of each animal for retesting or for verification of slaughter.
From 4-108. Item 2 is the preprinted number on the 4-108.
5. Indicate which page of 4-108B this is and how many total
pages were completed.
6. List each animal (except steers or reactors) removed from
the herd for any reason since it became infected (if this date can be established) or otherwise for the 2-year period prior to discovery of infection.
6-A. Record the full legal name and mailing address of the
recipient of each animal. Each animal should be listed individually if individual identification is available; otherwise they may be listed by transaction lots.
6-B. Record the date this herd owner gave up control of the
animals.
6-C. Indicate the number of animals involved with each
transaction.
6-D. Record all available identification at time of sale (removal
and E. from premises) for each animal including eartags, salestags,
backtags, bangle tags, brands, identification tattoos, and registration numbers.
6-F. Enter F (female) or M (male). If a lot, indicate the number
of each.
6-G. Age at time of removal from herd. If a lot, indicate the
average or predominant age.
6-H. Indicate the specific breed. If nondescript, indicate the breed
that the animal most appears to represent. For lots, enter the predominant breed or record as mixed beef, etc.
6-I. Record the vaccination status as “CV,” “AV,” “NV” (not
vaccinated), or “UN” (unknown) and list the vaccination tattoo, if applicable.
6-J. Indicate disposition of animals by recording “S” for slaughter,
“F” for feedlots, veal feeding, dairy heifer lot, etc., and “H” for herd replacement.
6-K. Indicate the status of the tracing on each animal by 1
(slaughter verified), 2 (located and retested), 3 (located but not tested), 4 (recipient state notified), or 5 (not verified).
6-L. Record the stage of pregnancy and other pertinent
information as of the time of sale. Also list the buyer if different than that given in A.
6-M. List status of animal when it left the herd or first point of
concentration.
7. Indicate if arrangements have been made to contact
everyone that received animals from this herd.
8-9. Self-explanatory.
Submit copies of any documents that may help trace the animals such as invoices, brand inspection, cancelled checks, etc.
VS FORM 4-108B (Reverse)
Form Copy Designations
Part 1-Herd file
Part 2-Cattle diseases staff,
Riverdale, MD (Free Areas only)
Part 3-Station Epidemiologist
Part 4- State or Federal Field
Veterinarian
File Type | application/msword |
File Title | See Notice/Instructions on Reverse |
Author | Government User |
Last Modified By | Khbrown |
File Modified | 2009-04-28 |
File Created | 2009-04-14 |