71.51 (b)(3) Admission of cats/dogs; death/illness

     

     

     

     

     

     

     

     

which arrived on

     

from

     

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLIC HEALTH SERVICE

CENTERS FOR DISEASE CONTROL

ATLANTA, GEORGIA 30333

NOTICE TO OWNERS AND IMPORTERS OF DOGS

(Please print)

POINT OF ENTRY - CITY

DATE (mm/dd/yyy)

OWNER'S NAME

PASSPORT No.

OWNER'S COMPLETE ADDRESS &, TELEPHONE No.

DRIVER'S LICENSE No.

STATE ISSUED

ADDRESS WHERE DOG(S) WILL BE CONFINED

The following dog(s) (number, type, age,and description):

(Kind of conveyance - Name of Ship; Flight No. of plane; Tag No. of Vehicle)

, is/are admitted

to the United States, subject to restrictions of section 71.51 of Public Health Service Foreign Quarantine Regulations checked below:

1.

days, which will complete a 30 day period from the date of the antirabies vaccination

(§ 71.51 (c) (2) (i).)

2.

(§ 71.51 (c) (2) (ii).)

3.

(§ 71.51 (c) (2) (iii).)

The above restrictions are imposed under section 71.51 Title 42, Code of Federal Regulations, and compliance is necessary before

legal quarantine control of the animal(s) is relinquished.

''Confinement'' as used above means ''restriction of an animal by the owner or his agent to a building or other enclosure in isolation

from other animals and from persons except for contact necessary for its care, or, if it is allowed out of such enclosure, muzzling the

animal and keeping it on leash.''

NOTICE TO OWNER:

Criminal penalties may be imposed for violating regulations enacted under 42 USC § 264. Under 18 U.S.C. §§ 3559 & 3557, individuals may be fined up to $250,000 if a violation of the regulation results in the death of a person, or up to $100,000 if a violation of the regulation does not result in a death.

(Signature of Government Officer)

(Name: Please print or type)

(Title)

Statement to U.S. Government Officer

I certify that I am the owner, or authorized representative of the owner, of the above listed dog(s). I further certify that I acknowledge

and will comply with the restrictions checked above. Also, I will be responsible for complying with any additional measures that may be

required by health departments or other authority in the State of destination.

Copy sent to:

state of destination

(Signature of Owner or Representative)

(Date - mm/dd/yyyy)

(See reverse side)

CDC 75.37 (f. 4.421)

OMB # 0920-0134

Expiration date: x/xx/xxxx

''Confinement" for

     

''Confinement" until three months of age; then antirabies vaccination to be followed by confinement for 30 days.

"Confinement" until antirabies vaccination at destination to be followed by ''confinement'' for 30 days.

     

     

     

State health officer in

U.S. Quarantine Station

     

     

Public reporting burden of this collection of information is estimated to average15 minutes 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. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden

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REV. 02/2009

CDC 75.37 (f. 4.421) (BACK)

For Public Health assistance, contact the appropriate office above.

CDC Miami Quarantine Station

Miami International Airport

PO Box 996488

Miami, FL 33299-6488

Ph: (305) 526-2910

Fax: (305) 526-2798

Jurisdiction: All ports in Florida. Also, pre-clearance ports in the Bahamas.

CDC Minneapolis Quarantine Station

Minneapolis-St. Paul International Airport

Lindberg Terminal

C/O CBP

4300 Glumack Drive

St. Paul, MN 55111-3010

Ph: (612) 725-3005

Jurisdiction: All ports in Minnesota, Nebraska, North Dakota and South Dakota.

CDC Newark Quarantine Station

Newark Liberty International Airport

Terminal B - Box 52

Newark, NJ 07114

Ph: (973) 368-6200

Fax: (973) 368-6004

Hours: 9:00 AM-5:30 PM Mon-Fri

Officer in Charge: John Bateman

Jurisdiction: All ports in New Jersey and Delaware.

CDC New York Quarantine Station

JFK International Airport

Room 219.016 Terminal 4 (E)

Jamaica, NY 11430-1081

Ph: (718) 553-1685

Fax: (718) 553-1524

Jurisdiction: All ports in New York, Connecticut, Pennsylvania, and Vermont. Canadian pre-clearance port: Montreal. Also, pre-clearance at Shannon and Dublin.

CDC San Diego Quarantine Station

3851 Rosecrans St.,

P.O. Box 85524, MS-P511B OBH

San Diego, CA 92138-5524

Ph: (619) 692-5659

Fax: (619) 692-8821

Jurisdiction: All ports and the U.S.-Mexico border in San Diego, Imperial Counties of Southern California and all U.S.-Mexico border crossings in Arizona, including Tucson Airport.

CDC San Francisco Quarantine Station

San Francisco International Airport

PO Box 280548 SFIA

San Francisco, CA 94128-0548

Ph: (650) 876-2872

Fax: (650) 876-2796

Officer in Charge: Susan Dwyer

Jurisdiction: All ports in Central and Northern California (46 counties).

CDC San Juan Quarantine Station

Luis Munoz Marin International Airport

Terminal D, 3rd floor

San Juan, PR 00937-0197

Ph: (787) 774-7812

Jurisdiction: All ports in Puerto Rico and the U.S. Virgin Islands.

CDC Seattle Quarantine Station

Seattle-Tacoma International Airport

Room S-2067

Seattle, WA 98158-1250

Ph: (206) 553-4519

Fax: (206) 553-0855

Hours: 7:30 AM-3:30 PM, Mon-Fri

Officer in Charge: Heather Hastings

Jurisdiction: All ports in Washington, Colorado, Idaho, Montana, Oregon, Utah, and Wyoming. Canadian pre-clearance ports: Edmonton, Calgary, Vancouver, and Victoria

CDC Washington Quarantine Station

Dulles International Airport

P.O. Box 17087

Washington, DC 20041

Ph: (703) 661-1320

Jurisdiction: All ports in Washington DC, Maryland, Virginia, and West Virginia.

CDC Anchorage Quarantine Station

4600 Postmark Drive, Suite NC 206

Anchorage, Alaska 99502

Ph: (907) 271-6301

Fax: (907) 271-6325

Jurisdiction: All ports in Alaska.

CDC Atlanta Quarantine Station

Hartsfield-Jackson International Airport

PO Box 45256

Atlanta, GA 30320

Ph: (404) 639-1220

Fax: (404) 639-1224

Jurisdiction: All ports in Georgia, Alabama, Arkansas, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee.

CDC Boston Quarantine Station

500 Terminal E 2nd floor

Logan International Airport

East Boston, MA 02128

Ph: (617) 561-5701

Jurisdiction: All ports in Massachusetts, Maine, New Hampshire, and Rhode Island.

CDC Chicago Quarantine Station

O'Hare International Airport

AMF O'Hare, POB 66012

Chicago, IL 60666-0012

Ph: (773) 894-2960

Fax: (773) 894-2970

Jurisdiction: All ports in Illinois, Indiana, Iowa, Kansas, Missouri, and Wisconsin. Canadian pre-clearance port: Toronto.

CDC Detroit Quarantine Station

2613 World Gateway Place

McNamara Terminal, Bldg. 830

Detroit, MI 48242

Ph: (734) 955-6197

Fax: (734) 955-7790

Jurisdiction: All ports in Michigan, Kentucky and Ohio.

CDC El Paso Quarantine Station

Center for Border Health Research

1100 N. Stanton, Ste 410

El Paso, TX 79902

Ph: (915) 577-0970 [ex. 12 or 20]

24-hour answering service number:

(915) 543-2829

Fax: (915) 541-1137

Jurisdiction: All ports in West Texas and New Mexico, including the U.S.- Mexico border for those two states.

CDC Honolulu Quarantine Station

Honolulu International Airport

300 Rodgers Blvd., #67

Honolulu, HI 96819-1897

Ph: (808) 861-8530

Fax: (808) 861-8532

Jurisdiction: All ports in Hawaii, Guam, and Pacific Trust Territories.

.

CDC Houston Quarantine Station

George Bush Intercontinental Airport (IAH)

3870 North Terminal Road

C/O CBP, International Arrivals

US Public Health Service, IA2.0833

Houston, Texas 77032

Ph: (281) 230-3874

Jurisdiction: All ports in East Texas (Seaports and Airports) and Oklahoma.

CDC Los Angeles Quarantine Station

Tom Bradley International Terminal

380 World Way

Room 1428 (Southside FIS area)

Los Angeles, CA 90045

Ph: (310) 215-2365

Fax: (310) 215-2285

Jurisdiction: All ports in Southern California (excluding the US-Mexico border counties),Nevada, and Arizona. Southern California counties include Los Angeles, Orange, San Bernardino, Riverside, Ventura, Santa Barbara, and San Luis Obispo.

U.S. QUARANTINE STATIONS AND DIVISION OF QUARANTINE HEADQUARTERS