Vs 5-38 Parasite Submission Form

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 numbers for this information collection are 0579-0047 and 0579-0048. 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

BRUCELLOSIS RING TEST RACK CHART

PLANT NAME

PLANT NUMBER

DATE COLLECTED

ROUND NUMBER

GRADE “A” OR OTHER (Specify)

OMB APPROVED
0579-0047 and
0579-0048
EXP. Date XX/XXXX

STREET ADDRESS

CITY

COUNTY

RACK NUMBER

MILK
FROM

SAMPLES COLLECTED BY

TO

DATE SAMPLES TESTED

FROM

CREAM
TO

NUMBER OFSAMPLES

LABORATORY TECHNICIAN

Arrange samples in mailing cartons according to patron numbers recorded on rack charts.
31

32

33

34

35

36

37

38

39

40

21

22

23

24

25

26

27

28

29

30

11

12

13

14

15

16

17

18

19

20

1

2

3

4

5

6

7

8

9

10

VS FORM 4-38
JAN 2009