Vs 5-19A Flock Inspection and Epidemiology Report Initial Flcok I

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 2 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 0579-0101 EXP DATE XX/XXXX
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES				FLOCK INSPECTION AND EPIDEMIOLOGY REPORT Initial Flock Inspection for Complete or Export Monitored Status In the Scrapie Flock Certification Program
Flock ID			Flock Name and Address	Flock Location if Different
PIN
Telephone
Inspector				Inspector ID				County
Inspection Date				Latitude				Longitude
Type of Flock __________ Purebred __________ Commercial __________ Feeder __________ Other __________________				SHEEP ­­­­­	INVENTORY Adult Males Adult Females Yearling Males Yearling Females Female Lambs/Kids Male Lambs/Kids Castrated Males Total					GOATS
Veterinary Practitioner Name
Species			Predominant Breed
Yes	No	INSPECTION CHECKLIST
		Sheep and goats inspected and found free of clinical signs of scrapie.
		Sheep and goats inspected and those over 1 year of age are officially identified.
		Discussed procedure for reporting of both scrapie suspect animals and the submission of samples. Written or computer records reviewed and contain the following information:
		Official and Secondary Identification Type of official ID ___________________________
		Sex.
		Breed.
		Copy of Flock Inventory Attached. Does the producer understand the following records will need to be kept in the future?
		Date of Birth for future natural additions to the flock.
		Sire and Dams official and secondary identification for future natural additions.
		Progeny Official and secondary identification and sex.
		Flock of Origin (including SFCP status) and date of acquisition for purchased animals.
		Animal deaths – date died and cause of death.
		Purpose, reason, date, and buyer name and address for animals which are sold.
		Records of 1 year old sheep sold as breeding animals and official ID replaced Does the owner anticipate any of the following activities to occur over the next year? If so discuss the implications of the activities on his/her flock status.
		Commingling of sheep with another producer’s sheep.
		Purchase of ewes from another producer.
		Purchase of rams from another producer.
		Use of semen and embryos.
Comments
Flock Owner Signature					Yes	No	Application Form Completed (VS Form 5-22)
Inspector Signature					Yes	No	Received Copy of SFCP Standards
					Yes	No	Meets Program Standards

VS 5-19A

MAR 2010