Form VS 5-13 VS 5-13 Owner/Hauler Statement for Sheep and Goats (Draft)

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-XXXX. The time required to complete this information collection is estimated to average .08 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-XXXX EXP: XX/XXXX
UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES				Owner / hauler statement for sheep and goats				DATE ANIMALS MOVED:
NAME AND ADDRESS OF OWNER					NAME AND ADDRESS OF HAULER (If different then owner)
Name					Name
Address					Address
CIty/State/zip code					CIty/State/zip code
Email (Optional)					Email (Optional)
Other Contact (Optional)					Other Contact (Optional)
type of movement
Check one of the movement types below, if none apply an owner/hauler statement is not required.
NOTE: An Interstate Certificate of Veterinary Inspection is required rather than an owner/hauler statement to cross a state line with a sexually intact sheep or goat that is not in slaughter channels and is not moving to a federally approved livestock market or to another premise of same flock
	To a livestock market for sale as feeder or slaughter animals					To an individual for personal slaughter
	To a federally approved livestock market with sheep or goats that don’t have official eartags					To an instate livestock market with sheep or goats that don’t have official eartags
	To another instate site to have official ID applied					To another premises of the same flock out-of-state
	To a slaughter establishment					To a terminal feedlot
	Other, please explain: _______________________________________________________
GROUP LOT ID NUMBER
Scrapie Flock ID based group/lot ID: flock ID-MMDDYY sequence number Example: MD123456-061216-2					PIN/LID based group/lot ID: PIN/LID MMDDYY sequence number Example: 004T5670-612161-2
FOR SHEEP/GOATS MOVING WITHOUT OFFICIAL ID If different from the owner, the name, address, and flock ID or PIN of the flock of origin. (not required for animals under 18 months of age in slaughter channels)
DECLARATION
Number of Animals		Species	Breed (If unknown: for sheep include face color, for goat include type; milk, meat, fiber)		Class (Cull ewes/does, replacement ewes/does, feeder lambs/kids, slaughter lambs/kids, etc.)		Comments
POINT OF ORIGIN (If different then owner)					NAME AND ADDRESS OF DESTINATION
Name					Name
Address					Address
CIty/State/zip code					CIty/State/zip code
phone					phone
Email (Optional)					Email (Optional)
Other Contact (Optional)					Other Contact (Optional)
Owner/Hauler Signature (I do hereby certify that the information stated above is correct and the livestock listed are properly classified.)								Date

VS FORM 5-13

NOV 2018