Form VS Form 17-30 VS Form 17-30 Report of Animals, Poultry, or Hatching Eggs Offered for

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 0579-0228. The time required to complete this information collection is estimated to average 1 hour 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 0579-0228 EXP XX/XXXX
HEALTH CERTIFICATE NO.			DOCUMENT NO.				PERMIT NO.
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES					REPORT OF ANIMALS, POULTRY, OR EGGS OFFERED FOR IMPORTATION
VEHICLE LICENSE NO.					SEAL NO.
ALT NO.					CBP CODE
NUMBER	UNIT OF MEASURE			SPECIES	BREED	TYPE		AGE	SEX	PURPOSE OF IMPORTATION
*PORT OF ENTRY
COUNTRY OF ORIGIN
IMPORTER
**FOR DELIVERY TO
LOCATED AT
CERTIFICATE OF INSPECTION OF ANIMALS, POULTRY, OR EGGS OFFERED FOR IMPORTATION This is to certify that I have inspected the listed animals, poultry, or eggs offered for importation for the purpose as reported above, have found them to be free of evidence of communicable diseases or exposure thereto, and otherwise to have met all other applicable provisions of 9 CFR Part 92, as amended.
REMARKS
DATE OF ISSUANCE		VETERINARY INSPECTOR
*(As obtained from the importer or the importer’s agent) **(Shipment not to be diverted without permission of port veterinarian)

VS FORM 17-30 Previous editions are obsolete

SEPT 2009