Form VS 9-2 VS 9-2 Flock Selecting and Testing Report

National Poultry Improvement Plan and Auxiliary Provisions

VS 9-2 JUL 2013

Private Sector

OMB: 0579-0445

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OMB Approved 0579-0007 and 0579-0445 See reverse side for additional information.

Report No. O


United States Department of Agriculture

Animal and Plant Health Inspection Service

National Poultry Improvement Plan


Flock Selecting and Testing Report

SUBPART

B - Egg Type Chickens

C - Meat Type Chickens

D - Turkeys

E - Waterfowl, Exhibition

Poultry, Backyard Birds,

and Game Birds

F - Ostrich

Other

CLASSIFICATION - U. S.


Pullorum - Typhoid Clean

M. Gallisepticum Clean

M. Synoviae Clean

Sanitation Monitored

M. Meleagridis Clean

Salmonella Enteritidis Clean


Salmonella Monitored

M.G. Monitored

M.S. Monitored

Avian Influenza Clean

H5/H7 Avian Influenza Clean

H5/H7 Avian Influenza Monitored

Other

TYPE



Primary



Multiplier


1. Name and Address of Flock Owner (Include ZIP Code)




2. Location of Flock



3. Date of Preceding Test – This Location

4. Supply Flock for: (Name and Address of Hatchery or Dealer – include ZIP Code)




NPIP Approval Number

5. Breed, Variety, Strain, or Trade Name of Stock



Age of Birds

Code Identification

6. Males (Source and Number)

Date of Hatch

7. Females (Source and Number)

Date of Hatch



8. Total Birds in Flock

Blood Testing

a. Number of Males Tested

b. Number of Females Tested

c. TOTAL Number Tested

d. Number of Reactors

e. Number Sent to Laboratory

f. Laboratory Findings

9. PULLORUM TYPHOID








10. M. GALLISEPTICUM








11. M. SYNOVIAE








12. AVIAN INFLUENZA








13. OTHER (Specify)







AGREEMENT OF FLOCK OWNER


I agree to keep my poultry breeding stock segregated from other poultry and in accordance with the provisions of the Plan and regulations of the official State Agency. I further agree to flock inspection by a representative of the official State Agency as prescribed by the provisions and regulations.

Signature of Inspector or Authorized Agent

Date

Signature of Flock Owner

Date

VS FORM 9-2 (JUL 2013) Previous edition may be used.

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

0579-0007 and 0579-0445. The time required to complete this information collection is estimated to average .16 – 4 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.



































This report is required by regulation (9 CFR 145). Failure to report can result in OMB Approved

non-classification of poultry and poultry products under the NPIP. 0579-0007 and 0579-0445





United States Department of Agriculture

Animal and Plant Health Inspection Service

National Poultry Improvement Plan




Flock Selecting and Testing Report









Report NUMBERS From _________________________________________ TO ________________________________________










VS Form 9-2 (JUL 2013) Previous edition may be used.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHardy, Kimberly A - APHIS
File Modified0000-00-00
File Created2021-01-23

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