VS 4-54D Monthly Report of Brucellosis Program Surveillance Activ

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 4 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 NO. 0579-0047 Expiration Date 00/00/0000

MONTHLY REPORT OF BRUCELLOSIS PROGRAM SURVEILLANCE ACTIVITIES

STATE NAME

STATE/AREA CLASS

MONTH AND YEAR

SECTION A – BLOOD TESTS ON MARKET CATTLE ORIGINATING IN THIS STATE

STATE WHERE SAMPLES WERE TESTED (If more space is needed use additional forms) A.

IDENTI FICATION

INITIAL SAMPLES COLLECTED AT:

TOTAL TESTED

Ranch or Farm

Stockyards

Federally Inspected Slaughter Plants

State inspected Slaughter Plants

Cattle B.

Reactors C.

Cattle D.

Reactors E.

Cattle F.

Reactors G.

Cattle H.

Reactors I.

Cattle J.

Reactors K.

1. MCI Cattle Tested in this State

a. Backtagged

b. Other ID

c. No ID

2.

a. Backtagged

b. Other ID

c. No ID

3.

a. Backtagged

b. Other ID

c. No ID

4.

a. Backtagged

b. Other ID

c. No ID

5.

a. Backtagged

b. Other ID

c. No ID

6.Total Cattle Tested which Originated in this State

a. Backtagged

b. Other ID

c. No ID

d. TOTAL

SECTION B – BLOOD TESTS ON MARKET CATTLE ORIGINATING IN OTHER STATES TESTED IN THIS STATE

STATE OF ORIGIN OF TESTED CATTLE (if more space is needed use additional forms) A.

IDENTI FICATION

SAMPLES COLLECTED AT:

TOTAL TESTED

Ranch or Farm

Stockyards

Federally Inspected Slaughter Plants

State inspected Slaughter Plants

Cattle B.

Reactors C.

Cattle D.

Reactors E.

Cattle F.

Reactors G.

Cattle H.

Reactors I.

Cattle J.

Reactors K.

7. MCI Cattle Tested in this State

a. Backtagged

b. Other ID

c. No ID

8.

a. Backtagged

b. Other ID

c. No ID

9.

a. Backtagged

b. Other ID

c. No ID

10.

a. Backtagged

b. Other ID

c. No ID

11.

a. Backtagged

b. Other ID

c. No ID

12.Total Cattle Tested which Originated in this State

a. Backtagged

b. Other ID

c. No ID

d. TOTAL

SECTION C – SUMMARY OF CATTLE TESTED AT FARMS OR STOCKYARDS ALSO TESTED AT SLAUGHTER

IDENTI FICATION A.

TOTAL TESTED

Ranch of Farm

Stockyards

Cattle B.

Reactors C.

Cattle D.

Reactors E.

Cattle F.

Reactors G.

a. Backtagged

b. Other ID

SECTION D – SUMMARY OF BLOOD SAMPLE COLLECTIONS AT SLAUGHTER BY VS PERSONNEL OR CONTRACTOR

Plant No.

Expense

No. Samples

Plant No.

Expense

No. Samples

Plant No.

Expense

No. Samples

VS 4-54D MAR 2009

SECTION E – TRACEBACK OF MARKET CATTLE REACTORS

TYPE OF IDENTIFICATION

MCI Reactors Pending Herd A.

Traced to Known Reactor Herd B.

Traced and test Recom mended C.

Traced and test not Recom mended D.

Traced to Dealer E.

Traced to Feedlot F.

Traced to Sold Out Herd

Traced to Another State I.

Unable to Trace J.

MCI Reactors Successfully Traced K.

Single Reactor G.

Multiple Reactors H.

13. Backtagged

14. Other ID

15. No Identification

16. Number of Herds

SECTION F – BRUCELLOSIS MILK AND CREAM RING TEST RESULTS

RING TEST RESULTS – HERDS LOCATED IN THIS STATE REGARDLESS OF WHERE TESTED

Round Number A.

TOTAL

NEGATIVE

SUSPICIOUS

Percent Suspicious Herds (F/B x 100) H.

17.

Herds (D + F) B.

Estimated Cattle (E + G) C.

Herds D.

Estimated Cattle E.

Herds F.

Estimated Cattle G.

18. Milk

19. Cream

20. Total

SECTION G – SUMMARY OF BRUCELLOSIS TESTS IN OTHER SPECIES )Report Swine on VS Form 4-59)

SPECIES NAME

TOTAL TESTED

TOTAL REACTORS

Suspects E.

Herds/Lots A.

Animals B.

Herds/Lots C.

Animals D.

21. Goats

22. Sheep

23. Horse

24. Bison

25. Deer

26. Elk

27. Canine

28. Other (Specify)

29.

30.

SECTION H – MONTHLY REPORT OF BRUCELLOSIS REACTOR HERDS/LOTS IN OTHER SPECIES

Herd/Lot ID Number A.

Species B.

C. Herd/Lot Name

County where herd/lot is Located F.

Total Animals Tested G.

Total Animals Tested H.

Total Animals Tested I.

Total Animals Tested J.

Total Animals Tested K.

D. City E. ZIP Code

C.

D. E.

C.

D. E.

C.

D. E.

C.

D. E.

C.

D. E.

C.

D. E.

C.

D. E.

C.

D. E.

SIGNATURE

TITLE

DATE

VS 4-54D (Reverse)