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 0579-0146. The time required to complete this information collection is estimated to average .25 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.
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OMB APPROVED 0579-0146
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UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES |
TUBERCULIN TEST RECORD (Special) |
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HERD OWNER – LAST NAME FIRST NAME MIDDLE INITIAL |
REASON FOR CFT OR SCT |
DATE INFECTED |
CFT OR SCT TEST |
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AREA 1. |
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HERD 6. RETEST |
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CFT OR SCT |
COMPARTIVE CERVICAL |
COMPLETE HERD TEST OF ALL ELIGIBLE ANIMALS YES NO IF NO |
NO. OF ELIGIBLE ANIMALS IN HERD |
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ROUTE – STREET – ROAD |
HERD(RE) 2. ACCREDITIATION. |
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TRACING 7. REG. KILL |
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RETEST OF CFT/SCT SUSPECTS YES NO |
COMPARATIVE RETEST 1st 2nd 3rd |
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MILK 3. ORDINANCE |
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TRACING 8. REACTORS |
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CC TEST RESULTS |
KIND OF HERD DEER ELK CATTLE BISON OTHER_____________ |
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POST OFFICE STATE (Including ZIP Code) |
SALE – 4. SHOW |
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TRACING 9. EXPOSED |
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NEG |
SUS |
REA |
TOTAL |
LOCATION OF CC TEST RIGHT SIDE OF NECK
LEFT SIDE OF NECK |
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TUBERCULIN |
SERIAL NO. |
LICENSE NO. |
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COUNTY
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TOWNSHIP |
SECTION |
HERD NO. |
IMPORTED 5. |
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OTHER 10. |
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AVIAN |
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MAMMALIAN |
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ANIMAL NUMBER |
OFFICIAL IDENTIFICATION NUMBER |
OTHER IDENTIFICATION |
AGE |
BREED |
SEX |
AVIAN PPD (UPPER) |
BOVINE PPD (LOWER) |
PREVIOUS CFT OR SCT RESPONSE |
CLASSIFI - CATION (CC TEST)
(N S R) |
REACTOR TAG NUMBER |
REMARKS |
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SKIN THICKNESS |
Mill- Meters
Increase |
SKIN THICKNESS |
Mill- Meters
Increase |
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Milli- Meters Normal |
Milli- Meters 72 Hours |
Milli- Meters Normal |
Milli- Meters 72 Hours |
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SIGNATURE
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TITLE |
DATE |
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VS FORM 6-22C (Feb 1999 editions may be used. All others are obsolete.)
JUN 2009
| File Type | application/msword |
| File Title | According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond |
| Author | Government User |
| Last Modified By | Khbrown |
| File Modified | 2009-07-09 |
| File Created | 2009-07-09 |