VS 4-52A Report of Back Tags Applied

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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB APPROVED
0579-0047

REPORT OF BACK TAGS APPLIED

WHERE APPLIED – NAME AND ADDRESS

1. RANCH OR FARM
2. PUBLIC STOCKYARDS
3. OTHER LIVESTOCK MARKETS
4. SLAUGHTER ESTABLISHMENTS

CHECK
ONE

VS FORM 4-52A
FEB 2011

(White Tag)

TAG
NUMBER

1. MARKET EMPLOYEE
2. REGULATORY PERSONNEL

(Yellow Tag)

PREFIX
NUMBER

TAGS APPLIED BY

3. CONTRACTOR
4. OTHER (Specify)
DATE
TAGS
APPLIED

SALES TAG
NO.

FOR
OFFICE
USE
ONLY

BRAND AND
LOCATION

HERD OWNER’S NAME

ADDRESS

COUNTY

BLOOD
TEST
RESULTS
N

S

R