VS 17-140A Continuation Sheet for United States Origin Health Certi

OMB Approved
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 0579-0020 and 0579-0432. The time required to complete this information collection is estimated to average .5 hours per response, including the
0579-0020
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
and 0579-0432
READ INSTRUCTIONS FROM VS FORM 17-140
This certificate is authorized by law (21 U.S.C. 112); while you are not required to respond, no health certificate can be validated unless the data requested is provided.
UNITED STATES DEPARTMENT OF AGRICULTURE
1. FIRST CONSIGNOR’S NAME (Last Name, First Name, Middle Initial, or Business Name)
2. CERTIFICATE
3. PAGE NUMBER
MARKETING AND REGULATORY PROGRAMS
NUMBER FROM
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VS FORM 17-140
VETERINARY SERVICES
16. CONSIGNEE’S NAME

CONTINUATION SHEET FOR
UNITED STATES ORIGIN HEALTH CERTIFICATE
STATEMENTS/CERTIFICATIONS

VS Form 17-140A
JAN 2011

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