VS 5-29 A Scrapie Test Record - Continuation Sheet

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 0579-0101. The time required to complete this information collection is estimated to average .3 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.
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

FLOCK OWNER'S NAME - LAST

Specimen #

SCRAPIE TEST RECORD
CONTINUATION SHEET
Complete all entries on VS Form 5-29 before using this form.
FIRST

Official ID Number

NOTE: Sample numbers on specimens must be the same as listed on
this form.

INITIAL

FLOCK ID

Designation
(pos, sus,
exp, me,
n/a)

OMB APPROVED
0579-0101
EXP DATE XX/XXXX

__ of __
VETERINARIAN

DATE
COLLECTED

Other ID Numbers

PAGE NO.

Age

Sex
(f,m,cm)

Breed
(if unknown,
face color)

3rd Eyelid Info

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

L

R

Seen
Unseen

Circle if the 3rd eyelid tissue came from the Left or Right
eye. Circle if the lymphoid tissue was Seen or Unseen

Remarks:

Circle if the 3rd eyelid tissue came from the Left or Right eye. Circle if
the lymphoid tissue was Seen or Unseen

VS FORM 5-29A
DEC 2011