VS 9-3 Report of Sales of Hatching Eggs, Chicks, and Poults

This report is requested by certain States for the interstate shipment of poultry products. Failure to report may result in non-acceptance of shipment.

See reverse side for OMB information

OMB Approved 0579-0007

Report NUMBER

U nited states Department of Agriculture Animal and Plant Health inspection service National Poultry improvement plan Report of sales of hatching eggs, chicks, and Poults

1. Date of shipment

2. name, physical address, and phone number of purchaser

3. name, physical address, and phone number OF producer or shipper

4. quantity

5. variety, strains, or trade name

6. product

7.sex

8.Type (intended use)

9. Classification – U.S.

Chicken Eggs

Turkey Eggs

Chicks

Poults

Other

Straight-run

Females

Males

Commercial Production Stock

Multiplier Breeding Stock

Primary Breeding Stock

Pullorum Typhoid Clean

M. Gallisepticum Clean

M. Synoviae Clean

M. Meleagridis Clean

S. Enteritidis Clean

Salmonella Monitored

Sanitation Monitored

Avian Influenza Clean

H5/H7 AI Monitored

H5/H7 AI Clean

M.G. Monitored

M.S. Monitored

OTHER (Specify)

Eggs

Meat

Other

Eggs

Meat

Other

Eggs

Meat

Other

10. remarks (Services performed on products in shipment, e.g., vaccination, beak trimming, dubbing, etc., but not necessarily certified by State Inspector.)

This is to certify that the above name producer or shipper is participating in the National Poultry Improvement Plan

11. Signature of state inspector

12. Date

VS FORM 9-3 (Previous editions are obsolete.)

DEC 2011

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 0579-0007. The time required to complete this information collection is estimated to average .25 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.

VS FORM 9-3 (Reverse)

This report is requested by certain States for the interstate shipment of poultry products. Failure to report may result in non-acceptance of shipment.

See reverse side for OMB information

OMB Approved 0579-0007

Report NUMBER

U nited states Department of Agriculture Animal and Plant Health inspection service National Poultry improvement plan Report of sales of hatching eggs, chicks, and Poults

1. Date of shipment

2. name, physical address, and phone number of purchaser

3. name, physical address, and phone number OF producer or shipper

4. quantity

5. variety, strains, or trade name

6. product

7.sex

8.Type (intended use)

9. Classification – U.S.

Chicken Eggs

Turkey Eggs

Chicks

Poults

Other

Straight-run

Females

Males

Commercial Production Stock

Multiplier Breeding Stock

Primary Breeding Stock

Pullorum Typhoid Clean

M. Gallisepticum Clean

M. Synoviae Clean

M. Meleagridis Clean

S. Enteritidis Clean

Salmonella Monitored

Sanitation Monitored

Avian Influenza Clean

H5/H7 AI Monitored

H5/H7 AI Clean

M.G. Monitored

M.S. Monitored

OTHER (Specify)

Eggs

Meat

Other

Eggs

Meat

Other

Eggs

Meat

Other

10. remarks (Services performed on products in shipment, e.g., vaccination, beak trimming, dubbing, etc., but not necessarily certified by State Inspector.)

This is to certify that the above name producer or shipper is participating in the National Poultry Improvement Plan

11. Signature of state inspector

12. Date

This is to certify that the description and classification of the products listed above are properly indicated.

13. Signature of state inspector

14. Date

VS FORM 9-3 (Previous editions are obsolete.)

DEC 2011

UNITED STATES DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES

NATIONAL POULTRY IMPROVEMENT PLAN

INSTRUCTIONS FOR USE OF VS FORM 9-3

REPORT OF SALES OF HATCHING EGGS, CHICKS, AND POULTS

This form is designed to cover certain sales made by National Plan hatcheries, dealers, and independent flock owners. Some States require this form to be used for some or all shipments coming into the State. Some foreign countries and/or importing purchasers may require this form.

This form will only be furnished to participants in the National Poultry Improvement Plan.

Items 1 through 10 of the report should be completed by the producer or shipper. The first (white) and last (yellow) copies should be removed for distribution indicated and the two remaining copies should be sent promptly to the producer or shipper’s Official State Agency for verification of checked classifications and counter signature and proper distribution.

Item No.

1-3. - Self Explanatory.

4. - Indicated number (not cases, boxes, or dozens) of each kind of product.

5. - Use a separate line to identify each product by variety, strain, or trade name.

6. - Product – describe each product by inserting an X in one of the 5 columns.

7. - Sex – Insert an X in one of the 3 columns, except for eggs.

8. - Type-Insert an X in one of the 3 columns as follows:

Commercial Production Stock-Products (eggs or baby poultry) not intended to be used for breeding purposes.

Multiplier Breeding Stock-Breeding stock whose progeny will be used for commercial egg or meat production or exhibition purposes and not intended for further reproduction.

Primary Breeding Stock-Breeding stock whose progeny will be used for further reproduction.

9. - Classification – Enter an X in the column for each NPIP classification for which the product is qualified.

10. - Self Explanatory.

11-12. - Signature of State Inspector and Date – May be signed prior to form being sent to participant.

13-14. - Signature of State Inspector and Date – Should not be signed until classifications checked by participant are verified by State Inspector.

VS FORM 9-3

DEC 2011

Form Copy Designation

Part 1 - To Accompany Shipment

Part 2 - Foreign Purchaser’s Copy or Domestic Purchaser’s Official

State Agency Copy (after items 13 and 14 are completed)

Part 3 - Shipper’s Official State Agency Copy

Part 4 - Shipper’s Copy