Form VS 6-38 VS 6-38 ACCREDITED AREA SURVEILLANCE FOR TUBERCULOSIS

Tuberculosis

VS Form 6-38

TUBERCULOSIS - STATE, LOCAL OR TRIBAL GOVERNMENT

OMB: 0579-0146

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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 0579-00146. The time required to complete this information collection is estimated to average 10 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

0579-0146

Exp. xx/xx/xxxx

The information in this report is needed for effective monitoring and management of the Tuberculosis Federal-State Cooperative Program (9 CFR Part 77).

UNITED STATES DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES


ACCREDITED AREA SURVEILLANCE FOR TUBERCULOSIS

STATE

STATE CODE

YEAR

SECTION I – BOVINE POPULATION AND HERD STATUS

SECTION II – BOVINE POPULATION AND HERD STATUS

TYPE OF BOVINE

TOTAL HERDS

A

TOTAL BOVINE

B

TYPE OF BOVINE

TOTAL HERDS

A

TOTAL BOVINE

B

1. Dairy



9. Deer



2. Beef



10. Elk



3. Total Bovine Population (Lines 1+2)



11. All Other



4. Accredited Herds



12. Total Cervine Population (Lines 1+2+3)



5. Herds Under Quarantine



13. Accredited Herds



6. M.bovis Confirmed or Suspicious Herds



14. Qualified Herds



7. Total No Herds Quarantined During Year



15. Monitored Herds



8. Total No. Herds Released From Quarantine During Year



16. Herds Under Quarantine



SECTION III – SLAUGHTER WITHIN THE STATE

17. M.bovis Confirmed or Suspicious Herds




TOTAL

BOVINE

A

TOTAL

CERVINE

B

18. Total No. Herds Quarantined During Year



20. No. Slaughtered



19. Total No. Herds Released From Quarantine During Year



21. No. of VS 6-35s



BREAKDOWN OF 20A (Total Bovine)

BREAKDOWN OF 20B (Total Cervine)

22. Rate of VS 6-35 Submissions (Line 14 (divided by) Line 13 x 100,000)



23. Mature


26. Mature


24. All Other


27. All Other


25. TOTAL


28. TOTAL


29. BREAKDOWN OF ITEM 20A

Federal Slaughter State Slaughter Both

30. BREAKDOWN OF ITEM 20B

Federal Slaughter State Slaughter Both

SECTION IV – NAMES OF M.bovis CONFIRMED OR SUSPICIOUS HERDS (List each Herd show in Item 6A and 17A)













ACCREDITATION REQUEST

APPROVAL (Staff Use Only)

We certify that this area is being maintained under and complies with provisions of:


The Uniform Methods and Rules governing Modified Accredited Status


The Uniform Methods and Rules governing Accredited Free Status

This area is approved as a tuberculosis:


MODIFIED ACCREDITED AREA


ACREDITED FREE AREA

SIGNATURE OF STATE OFFICIAL



NAME OF STATE OFFICIAL (Please print or type)

DATE

SIGNATURE OF FEDERAL PRIVATE PRACTITIONER IN CHARGE



NAME OF FEDERAL V-I-C (Please print or type)

DATE

SIGNATURE OF VETERINARY SERVICES OFFICIAL



NAME OF V-S-O (Please print or type)

DATE


VS FORM 6-38 PAGE 1 OF 2

JUNE 2009


SECTION V – SPECIAL RETEST OF HIGH RISK HERDS (UM&R, PART X)


TESTS OF HERDS WITH M.bovis INFECTION CONFIRMED BUT HERD NOT DEPOPULATED


HERD OWNER

QUARANTINE RELEASE

1ST; 1 YR RETEST

2ND; 1 YR RETEST

3RD; 1 YR RETEST

4TH; 1 YR RETEST

5TH; 1 YR RETEST

1ST; 3 YR RETEST

2ND; 3 YR RETEST









































































TESTS OF HERDS WITH HISTORY OF LESIONS SUSPICIOUS OF M.bovis BUT NOT CONFIRMED

HERD OWNER

QUARANTINE RELEASED

1ST ANNUAL RETEST

2ND ANNUAL RETEST

OTHER































REPORT OF PREMISES WHERE A TUBERCULOSIS HERD WAS DEPOPULATED

HERD OWNER

DATE RESTOCKED


1ST RETEST

(in 6 months)

2ND RETEST 1 YEAR AFTER 1ST

3RD RETEST 3 YRS AFTER 2ND

4TH RETEST 3 YEARS AFTER 3RD
























































VS FORM 6-38 (Reverse) PAGE 2 OF 2

JUNE 2009

File Typeapplication/msword
File TitleAccording to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
AuthorKhbrown
Last Modified ByKhbrown
File Modified2009-06-08
File Created2009-06-08

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