VS 17-140B Continuation Sheet for United States Orgin Health Certif

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 is 0579-0020. 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 0579-0020
READ INSTRUCTIONS FROM VS FORM 17-140
This certificate is authorized by law (21 U.S.C. 112), while you are not required to respond, no health certificate can be validated unless the data requested is provided.
United States Department of Agriculture Marketing and Regulatory Programs Animal and Plant Health Inspection Service Veterinary Services Continuation Sheet for United States Origin Health Certificate	1. First Consignor’s Name (last name, first name, middle initial, or business name)	2. Certificate Number from VS form 17-140	3. Page Number OF
	16. Consignee’s Name
Statements/Certifications

VS Form 17-140B

JAN 2011