7001A United States Interstate and International Certificate o

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 0579-0036. The time required to complete this information collection is estimated to average .25 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.						No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by USDA regulation shall be delivered to any intermediate handler or carrier for transportation in commerce, unless accompanied by a health certificate executed and issued by a licensed veterinarian (7 USC 21.43.9 CFR, Subchapter A, Part 2).							OMB APPROVED 0579-0036 Exp. XX/XXXX
U.S. DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE UNITED STATES INTERSTATE AND INTERNATIONAL CERTIFICATE OF HEALTH EXAMINATIONFOR SMALL ANIMALS (Continuation Sheet)									1. Certification number (Insert certificate number from page 1)
									2. page _________ of __________
3. Name, Address and telephone number of owner/consignor USDA License or Registration Number If Applicable Telephone					4. Name, Address and telephone number of consignee USDA License or Registration Number If Applicable Telephone
5. Animal identification (To be completes by owner/consignor)					6. vaccination history (To be completed by Veterinarian)						a ttach original signature Rabies certificate here
Complete USDA Tag Collar and/or Tattoo Number	Breed – Common Or Scientific Name	AGE	SEX	Color or Distinctive marks	Rabies Killed Virus Live Virus			D-H-L			Other vaccinations Tests or treatment
					Date		Product	Date		Product	Date	Type/Result
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
(27)
(28)
(29)
(30)
(31)

APHIS Form 7001A This certificate is valid for 30 days after issuance

JUN 2009