VS 4-6 Justification for Brucellosis Herd Depopulation

According to the Paperwork Reduction Act of 1995, an agency may not consider 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 collection is 0579-0047. The time required to complete this information collection is estimated to average .17 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

TELECOPIER JUSTIFICATION FOR BRUCELLOSIS HERD DEPOPULATIONS

1. SUBMITTED BY:

2. DATE SUBMITTED

3. SUBMITTED TO:

4. NAME OF HERD OWNER

5. STREET ADDRESS

6. COUNTY

Modified Certified Free

7. STATE

TEST HISTORY (If more space is needed, attach additional sheets)

8. TEST DATES

9. PLATE - TUBE

10. BBA

11. RIVANOL

12. OTHER RESULTS REMARKS

13. DATE “R” REMOVED FROM FARM

N

R

S

N

R

N

TITER

HERD HISTORY (Also submit a narrative report if necessary)

14. ISOLATIONS: (Results and dates)

15. MCI Yes No

Date (If yes)

Stockyards Slaughter

16. BRT Yes No

Date (If yes)

Beef NA

17. ABORTIONS Yes No

Date (If yes)

Percent %

18. STRAIN 19 CV HISTORY

Percent CV in adult herd %

Percent CV in replacement heifers %

19. CONTACT HERDS: (List contact herds with test results and dates)

20. ECONOMIC IMPACT ON HERD OWNER, IF NOT DEPOPULATED:

21. IMPACT ON MANHOURS IN STATE, IF NOT DEPOPULATED:

INVENTORY TO DEPOPULATE

Registered

22. NO. ADULTS

23. NO. CALVES

24. STEERS (Ineligible)

25. ESTIMATED INDEMNITY $

COWS

BULLS

FEMALE

MALE

Grade

APPROVED BY

26. SIGNATURE OF STATE OFFICIAL

27. TITLE

28. DATE

29. SIGNATURE OF FEDERAL OFFICIAL

30. TITLE

31. DATE

32. SIGNATURE OF REGIONAL DIRECTOR

33. DATE

VS FORM 4-6 USDA – APHIS

APR 2009