VS 17-130 Ruminants Imported to Designated/Approved Feedlots

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 num ber. The valid OMB control numbers for this information collection are 0579-0234 and 0579-XXXX. The tim e required to complete
this information collection is estimated to average .5-2 h ours 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

OMB Approved
0579-0234 and 0579-XXXX

1. PORT OF ENTRY

RUMINANTS IMPORTED TO DESIGNATED/APPROVED FEEDLOTS
Port Veterinarian - Complete #1 through 12 and attach copy of health certification.

2. ENTRY DATE

Distribute copies as indicated below.
Accredited Veterinarian or other designated individual at the feedlot - complete #13-18 and return original to Port Veterinarian (see #12) within 14 days of
receipt of the animals. The animals identified below (official animal identification is on the attached Health Certificate) were imported in accordance with USDA,
APHIS regulations for shipment to feedlots and are under your supervision. These animals must remain at this feedlot (see # 9) and sent to slaughter before they
are 30 months of age (for cattle, bison) or 12 months of age (for sheep, goats) in a sealed vehicle using VS Form 1-27. Official animal identification cannot be
removed from these animals.
3. TO: (Accredited Veterinarian or other designated individual at feedlot (Address, Include Phone Number, and ZIP Code))

+

,

.

-

4. NUMBER OF ANIMALS

6. TRUCK (Trailer) LICENSE NUMBER

5. SPECIES OF ANIMALS

8. NAME AND ADDRESS OF CONSIGNOR (Include Phone Number
and ZIP Code)

7. SEAL NUMBERS

S A M PL E

9. NAME AND ADDRESS OF FEEDLOT (Include Phone Number and
ZIP Code)

10. NAME AND ADDRESS OF CONSIGNEE (Include Phone Number
and ZIP Code)

11. SIGNATURE OF PORT VETERINARIAN
12. PORT VETERINARIAN (Include Phone Number and ZIP Code)

+

,

.

-

»

Return the completed original to

RECEIPT OF SHIPMENT
This is to certify that, except as noted in #16, all animals identified above and on the attached health certificate were received and will remain at the loca tion in
#9 until sent to slaughter. This shipment must be sealed when it arrives at this feedlot. If any official seals are broken or missing, I will immediately contact the
Port Veterinarian. Identification of dead animals must be included in #16.

13. DATE RECEIVED
15. NAME AND ADDRESS OF FEEDLOT (Include Phone Number and
ZIP Code)

14.
a. I observed that all seals listed in #7 were present
and intact.
Veterinarian was contacted within 24 hours of receipt.

16. REMARKS

17. NAME OF DESIGNATED INDIVIDUAL (Print)

VS FORM 17-130 (DEC 2004)

Yes

No

Yes

No

b. If any listed seals are missing or broken the Port

18. SIGNATURE OF DESIGNATED INDIVIDUAL

Copy Designation to go at bottom right corner of form in RED Ink

COPY DESIGNATION:

ORIGINAL: To accompany shipment to feedlot
COPY: Retained by port
COPY: Retained by feedlot
COPY: AVIC
COPY: State Veterinarian