vs 17-20 United States Application/Permit to Import Birds

NO BIRDS MAY BE IMPORTED UNLESS ACCOMPANIED BY A VALIDATED IMPORT PERMIT (9 CFR 92).
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
WASHINGTON, D.C. 20250

UNITED STATES APPLICATION/PERMIT TO IMPORT BIRDS

This document not valid unless Section B
completed by an employee of Veterinary
S
i
SECTION B - USDA OFFICIAL USE ONLY

INSTRUCTIONS TO IMPORTER: Complete items 1 through 13 in Section A,
Illegibility, typographical errors or lack of information may delay the validation of
permits. Mailing instructions are on the reverse of the last page. The application for an
import permit becomes a valid permit when Section B is completed. See
responsibilities below.

14. DATES VALIDATED
FROM

SECTION A - TO BE COMPLETED BY APPLICANT (Please type)
1. NAME AND ADDRESS OF QUARANTINE FACILITY (Street, City, State and Zip Code)

FORM APPROVED: OMB NO. 0579-0040

See reverse side for additional OMB information.

15. PERMIT NO

TO

2. COUNTRY OF ORIGIN
16. VALID ONLY AT THIS U.S. PORT OF ENTRY

Note: Name and address of shipper (Exporter) is to be verified (on reverse
side of this page) at the time of arrival of birds.
4. BIRDS
3. NAME AND MAILING ADDRESS OF PERSON IN U.S. TO WHOM PERMITS ARE TO BE
MAILED

A. NO.

QUARANTINE AT PORT OF ENTRY REQUIRED

B. COMMON OR SCIENTIFIC NAME (Genus and Species) (Be specific)

17. MINIMUM NO. DAYS

18. NAME AND ADDRESS OF PORT VETERINARIAN

TELEPHONE NO. (Include Area Code)

5. PURPOSE OF IMPORTATION

19. VALIDATING SEAL, OFFICIALS SIGNATURE AND REMARKS

6. PORT OF EMBARKATION AND COUNTRY

7. PROPOSED SHIPPING DATE

8. ROUTE OF TRAVEL INCLUDING ALL CARRIER STOPS ENROUTE (Detailed flight data may
be requested)

NO OTHER STOPS PERMITTED

Total birds authorized for Importation
(Limited to Facility Capacity)

CERTIFICATION OF OPERATOR OF QUARANTINE FACILITY (If operator same as Importer sign item 11 only). As the operator of the facility (in item 1) I agree to handle the shipment for the Importer
(in item 11) and further agree to comply with the conditions for Importations listed on the reverse of the Original copy of this form.
9. SIGNATURE OF OPERATOR OF FACILITY (In item 1)

10. DATE SIGNED

I have read the conditions for importation listed on the reverse and do agree t o comply with these 12. NAME AND ADDRESS OF IMPORTER (If different from item 1)
conditions and understand that non compliance jeopardizes the issuance of futur e permits.

20. NAME AND TITLE OF VALIDATING OFFICIAL

11. SIGNATURE OF IMPORTER

13. DATE SIGNED

21.

THIS PERMIT
VOID AFTER

NOTE: Conditions for Importation and Health Certification on reverse. Health Certification must be executed, failure to do so could necessitate rejection at the Port of Entry.
THE U.S. IMPORTER must forward the "Original" and "Carrier's Copy" to the shipper in the country of origin; and must make arrangements at the U.S. Port of Entry for Customs br okers' service if desired, necessary quarantine space and transportation of the shipment to and
from quarantine. The "Importer's Copy" to be retained.
THE SHIPPER in the country of origin must make certain the Health Certification (On the r everse of Original) is completed by a salaried veterinary officer of the Nation al Government of the country from which the birds are shipped; and deliver "Ori ginal" and "Carrier's Copy" to
the initial transporting carrier.
THE SALARIED VETERINARY OFFICER of the National Government of the country of origin is being forwarded a copy of this permit and is responsible for insuring that the necessary inspections a nd Health Certification (On reverse of Original) are completed, provided
circumstances are such that the certification be properly issued.
THE INITIAL CARRIER must make certain that the Health Certification (On reverse of Original) has b een completed and signed by a salaried veterinary officer of the National Gover nment of the country from which the birds are shipped; make sure that the "Orig inal" (With
Health Certification on reverse) accompany the birds to the U.S. Port of Entry; and make certain the "Carrier's Copy" is available for the final carrier who will transport the shipment to the U.S. Port of Entry.
VS VETERINARIAN AT PORT OF ENTRY will hold the "Customs Copy" until the shipment is received, then forward it t o the U.S. Collector of Customs. The "Original" (With the signed Health Certif ication on the reverse) will be retained by the VS veterinarian at U.S. Port of
entry.
VS FORM 17-20 (JUNE 98)

CONDITIONS FOR IMPORTATION
1. The importer agrees to import the birds authorized by this permit in accord ance with the provisions of Part 92, Title 9, CFR, all agreements existing between Veterinary
Services and the owner of the facility.
2. The birds will be shipped by the route indicated on the face of the permit.
3. The importer agrees upon arrival of the birds a the port of entry that they shall be accepted from the carrier in the presence of Veterinary Services personnel and transported
in a sealed vehicle or accompanied by Veterinary Services personnel to the quarantine facility.
4. Lots refused entry shall be removed from the United States or disposed of by the importer after official notification by the U.S. Department of Agriculture, as provided in
Section 92.8(a), Part 92, Title 9, Code of Federal Regulations.
5. If USDA approved quarantine space is not available to handle this shipment upon arrival, this permit is automatically canceled and the shipment ill be ref used entry. The
Deputy Administrator, Veterinary Services, for other reasons may cancel the permit.
6. Applicable U.S. Department of the Interior's regulations 50 CFR, Parts 14, 16, 17, and 21 must be met.

HEALTH CERTIFICATION
The following certification must be signed by a full-time salaried veterinary o fficer of the national government of the country of export.
I certify that I personally inspected all of the birds, immediately prior to exportation, described in item 4 of VS Form 17-20, and that no evidence of Newcas tle disease, ornithosis, or
other communicable disease of poultry was found, nor inso far as has been possi ble to determine, were the birds exposed to any such diseases during the 90 days immediately
prior to the inspection date listed below. The birds were placed in new shipping containers at the premises of origin and insofar as is known, the birds have not been vaccinated with
Newcastle disease vaccine, Newcastle disease has not occurred on the premises of origin, nor on adjoining premises during the 90 -day period immediately prior to exportation and
that these premises are not located inan area under quarantine for poultry dise ases during the preceding 90 days.
I further certify that the name and address of the exporter below was furnished to me by the shipper of the birds which I inspected.
(See item 2 "NOTE" on front of this page.)

EXPORTERS NAME AMD ADDRESS (Print or type in English - Verify at time of arrival of birds.)

NAME AND ADDRESS OF VETERINARY OFFICER (Print or type)

SIGNATURE
TITLE (Print or type)

DATE SIGNED

CONDITIONS FOR IMPORTATION
1. The importer agrees to import the birds authorized by this permit in accord ance with the provisions of Part 92, Title 9, CFR, all agreements existing between Veterinary
Services and the owner of the facility.
2. The birds will be shipped by the route indicated on the face of the permit.
3. The importer agrees upon arrival of the birds a the port of entry that they shall be accepted from the carrier in the presence of Veterinary Services personnel and
transported in a sealed vehicle or accompanied by Veterinary Services personnel to the quarantine facility.
4. Lots refused entry shall be removed from the United States or disposed of by the importer after official notification by the U.S. Department of Agriculture, as provided in
Section 92.8(a), Part 92, Title 9, Code of Federal Regulations.
5. If USDA approved quarantine space is not available to handle this shipment upon arrival, this permit is automatically canceled and the shipment ill be re fused entry. The
Deputy Administrator, Veterinary Services, for other reasons may cancel the permit.
6. Applicable U.S. Department of the Interior's regulations 50 CFR, Parts 14, 16, 17, and 21 must be met.

MAIL APPLICATION AS INDICATED BELOW
A.
IF QUARANTINE
FACILITY LOCATED IN:

B.
SEND FORM VS 17-20
TO:

C.
IF QUARANTINE FACILITY
LOCATED IN:

D.
SEND FORM VS 17-20
TO:

E.
IF QUARANTINE
FACILITY LOCATED IN:

New York........................

USDA, APHIS, VS
80 Wolf Road, Suite 503
Albany, NY 12205

Florida...........................

USDA, APHIS, VS
California.........................
P.O. Box 660657
Miami Springs, FL 33266

Michigan............................

USDA, APHIS, VS
300 South Walnut
Lewis Case Building
Lansing, MI 48913

Louisiana........................

USDA, APHIS, VS
P.O. Box 1391
Baton Rouge, LA 70821

Illinois..............................

USDA, APHIS, VS
P.O. Box 3126
Springfield, IL 62708

Texas................................

USDA, APHIS, VS
702 Colorado Street
Room 301
Austin, TX 78701

F.
SEND FORM VS 17-20
TO:
USDA, APHIS, VS
83 Scripps Drive
Sacramento, CA 95825

Washington........................ USDA, APHIS, VS
406 General
Administration Building
Olympia, WA 98504

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to re spond to, a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0579-0040. The tim e required to complete this information collection is estimated to average 1 ho ur
per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the co llection of
information.