APHIS 7043 Confinement Agreement

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 numbers for these information collections are 0579-XXXX. The time required to complete these information collections 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.			OMB Approved 0579-XXXX
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE Animal care	Confinement Agreement
The name and address of the person intending to import the dog(s) into the continental United States or Hawaii
The name and address of the person importing the dog(s) into the continental United States or Hawaii
The number of dogs to be imported and the breed, sex, age, color, markings, and other identifying information of each dog
The purpose of the importation
The port of embarkation and the mode of transportation
The port of entry in the continental United States or Hawaii
The proposed date of arrival in the continental United States or Hawaii
The name and address of the person to whom the dog(s) will be delivered in the continental United States or Hawaii and, if the dog(s) is or are imported for research purposes, the USDA registration number of the research facility where the dog will be used for research, tests, or experiments
Reason for confinement
Days in confinement
Signature		Date

APHIS Form 7043

SEP 2011