VS 9-6 Report of Salmonella Isolations to NPIP Official State A

National Poultry Improvement Plan (NPIP)

9-6.2.KAY

NPIP State

OMB: 0579-0007

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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 of this information collection is 0579-0007. The time required to complete this information collection is estimated to average .5 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

0579-0007

This report is required by Regulations (9 CFR Part 145). Failure to report will hinder investigation of disease to determine origin of the infection.

UNITED STATES DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

NATIONAL POULTRY IMPROVEMENT PLAN

REPORT OF SALMONELLA ISOLATIONS TO NPIP OFFICIAL STATE AGENCIES

(This report is issued as an aid to the detection of sources of Salmonella infections

but does not imply responsibility or liability for the infection)


1. LABORATORY ACCESSION NO.

2. NAME AND LOCATION OF STOCK




3. BREED, VARIETY, OR CROSS



4. INTENDED USE OF FLOCK

Breeding Non-breeding

5. PERSON SUBMITTING SPECIMENS



6. DATE OF SUBMISSION

7. REPORTED HATCHERY SOURCE



SPECIMENS SUBMITTED

8. NO OF CHICKENS

9. NO. OF TURKEYS


10. NAME AND NO. OF OTHER SPECIES

11. APPROXIMATE AGE

12. ISOLATIONS Pullorum

Typhoid Paralphold

13. SPECIFY OTHER SEROTYPE

14. REMARKS (Include any information which may aid in determining the source of infection)






15. NAME AND ADDRESS OF DIAGNOSTIC LABORATORY (Include ZIP Code)


16. REPORT SUBMITTED BY




17. DATE REPORT SUBMITTED


VS Form 9-6

MAY 2009













COPY DESIGNATIONS


PART 1 – LOCAL OFFICIAL STATE AGENCY


PART 2 – OFFICIAL STATE AGENCY

OF HATCHERY SOURCE


PART 3 – POULTRY IMPROVEMENT STAFF

APHIS, RIVERDALE, MD


PART 4 – LABORATORY COPY

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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 Bykahardy
File Modified2009-06-18
File Created2009-02-10

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