VS 4-80 Application for Validated Brucellosis-Free Herd Certific

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 0579-0047. The time required to complete this information collection is estimated to average .083 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 0579-0047 Exp. 00/00/0000
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES In cooperation with APPLICATION FOR VALIDATED BRUCELLOSIS-FREE HERD CERTIFICATE
HERD OWNER’S NAME
HERD OWNER’S ADDRESS
COUNTY		TOWNSHIP	SECTION	SIZE OF BREEDING HERD		MALES		FEMALES
QUALIFYING HERD TESTS
DATE	NEGATIVE		REACTOR		TOTAL
The owner of the herd described above having submitted all breeding swine 6 months of age and older for the required negative blood tests hereby make application for the Validated Brucellosis-Free Herd Certificate. Having met the requirements for a Validated Brucellosis-Free Herd, the owner will be issued an appropriate certificate designating the dates of the validation period and a metal farmstead sign bearing the month and year validation was achieved. The validation certificate will be in effect for the designated period, unless revoked or replaced due to revalidation of the herd. The Validated Brucellosis-Free Herd may be revalidated by passing an annual negative test of all breeding swine 6 months of age or older. When a herd is revalidated the owner will be issued a new Validated Brucellosis-Free Herd Certificate and a set of stickers for the metal farmstead sign showing the month and year the herd was revalidated. The owner agrees to maintain the herd in accordance with the current Uniform Methods and Rules and in compliance with current State regulations.
Signature of Owner					Date

VS FORM 4-80

APR 2009