VS 9-12A Grower Contract Worksheet - Layers (Continuation Sheet)

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 OMB control number for this information collection is 0579-XXXX. The time required to complete this information collection
is estimated to average .5 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-XXXX
Exp.: XX/XXXX

Grower Contract Worksheet – Layers
(Continuation Sheet)

Premises ID where birds are located:

Barn or Flock Number

VS FORM 9-12a
JAN 2016

Bird Placement
Date

Average Daily
Egg
Production

Date through
which eggs
have been
reimbursed

Amount expected
for eggs
produced since
last payment

Process used to determine expected contract
payment (e.g., price per bird and average load
out numbers, flat rate, average of last flocks,
etc.)