Form VS 5-38 VS 5-38 PARASITE SUBMISSION FORM

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 displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0090. The time required to complete this information collection is estimated to average .17 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 0579-0090
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES				PARASITE SUBMISSION FORM				NATIONAL VETERINARY SERVICES LABORATORIES 1920 Dayton Avenue Ames, IA 50010 Phone: (515) 337-7266
INSTRUCTIONS: Print in pencil or type. Prepare separate form or each species of animal. Form to accompany specimen. Package specimens well to prevent breakage enroute.
1. Submitter’s Name					2. NVSL Submitter ID		17. Specimen ID			18. Date collected
3. Name of Business							19. County in which collected			22. Premises ID
4. Address							20. State in which collected			23. Latitude
5. City	6. State				7. ZIP Code		21. Country in which collected			24. Longitude
8. Phone (Area Code)		9. Fax					25. Host origin
10. Email							26. Host Species (cow, horse, sheep, dog, etc.)
11. Owner’s Name							27. Where found on host (head, ear, flank, back, etc)
12. City	13. State				14. ZIP Code		28. Animal ID
15. Collector’s Name					16. Port		29. No. Animals in lot			30. No. Animals infested
31. History or additional information
FOR FIELD LABORATORY USE ONLY (Optional)
32. Date Received			33. Date Identified						34. Referral Number
35. Tentative Identification Identified By:
FOR NATIONAL VETERINARY SERVICES LABORATORIES USE ONLY
36. Case Number			37. Sample Number						38. Date Received
39. NVSL Identification Identified By: Date
						40. NVSL Accession Number

VS FORM 5-38 Previous editions may be used.

JUN 2009

GUIDELINES AND EXPLANATORY DETAILS FOR VS FORM 5-38: PARASITE SUBMISSION FORM

USDA, APHIS, VS, NATIONAL VETERINARY SERVICES LABORATORIES, AMES IA

INSTRUCTIONS: Print in pencil or type. Form must accompany specimen. Package specimens to prevent leakage en route. Despite best efforts. Specimen vials may break or leak alcohol in transit; when that happens, accompanying forms that were completed in ink may become illegible.

1-10. Submitter Information: If the submitter has an ID assigned previously by the NVSL, give the name of the submitter and that ID. For new submitters, or if the ID is not known, please also give the name of the business, mailing address, e-mail address, and telephone and FAX numbers, to whom the identification report will be sent.

11-14. Owner Information: Give the name, city, Sate, and ZIP Code of the owner of the host animal.

15. Collector’s name: For multiple collectors, additional names may be given in History or additional information (Field 31).

16. Port: Enter the port of entry, if applicable.

17. Specimen ID: The collector may indicate an identifier for a sample, usually denoting samples taken in series (1, 2, 3, etc.). Please also put that number or other identifier on or in the associated sample container. See also instructions for Referral number (Field 34).

18. Date collected: Enter the calendar date on which the sample was collected from the host animal.

19-21. County, State, and country in which (specimens) collected: Specify country only for non-USA collection locales.

22-24. Premises ID, Latitude, and Longitude: Give the Premises ID and geographical coordinates (if known). List coordinates as decimal degrees when possible (e.g., N27.087821 and W92.021484).

25. Host origin: Indicate the county, state, and country (if not the USA) of origin of the host animal.

26. Host species (Cow, horse, sheep, dog, etc.): State the host species from which the parasites were collected. Give only one species, be as specific as possible, and avoid generic terms like “equine”, “avian”, “reptile”, “canine”, “feline”, etc. Use a separate parasite submission form for each host species. If using “deer”, list the kind of deer (white-tailed, mule, etc.). For convenience, names used as examples may be encircled or underlined.

27. Where found on host (head, ear, flank, back, etc.): Indicate one or more anatomical sites where the specimen(s) was or were found. Names used as examples may be encircled or underlined.

28. Animal ID: Give ear/back tag numbers, animal name, or other information that identifies the host animal.

29. No. (Number of) animals in lot: Give a count or estimate of the number of individual animals in the group from which the collection was made.

30. No. (Number of) animals infested: Give a count or estimate of the number of individual animals in the lot that were infested with parasites; this count will be less than or equal to the number in the lot.

31. History or additional information: This field is open-ended, and may be used to include any additional information pertinent to the collection (e.g., locale, history, quarantine status, additional collectors, etc), observations on host animal condition, or additional details. This field also may be used for notes or requests to the identifier(s).

Fields 32-35 are for tentative identifications made at a field laboratory.

34. Referral number: Give submitter’s unique identification number assigned to the sample (e.g., foreign animal disease [FAD] investigation number).

Fields 36-40 are for NVSL use only.