Vs 17-65c Post Entry Quarantine Record Of Zoo Animals

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 number for this information collection is
0579-0040. The time required to complete this information collection is estimated to average .19 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.

No zoo animals can be released from quarantine
for movement to an approved zoological park
unless this form is completed at the New York
Port of Entry (9 CFR Part 93).

1. VS FORM 17-30 NO.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB APPROVED:
0579-0040
EXP. DATE
XX/XXXX

2. PERMIT NO.

POST ENTRY QUARANTINE RECORD OF ZOO ANIMALS
3. COUNTRY OF ORIGIN

NOTE: Health Inspection on Reverse

INSTRUCTIONS: Please type or print. Signatures in ink only. VS Quarantine Station-Complete items 1
through 16 on all copies. Send yellow to Riverdale. Send pink, green, and white to Zoo. Zoo Official4. PORT OF EMBARKATION
Complete items 17 through 19 on all copies, send green and white to VS Field Station, retain pink. VS Field
Station-Retain green and send white to Riverdale, MD office.
5. TATTOO

6. SPECIES (Description)

7. SEX

10. IMPORTER (Name and address include ZIP Code)

15. DESTINATION - APPROVED ZOO (Name and address,
include ZIP Code)

8. ESTIMATED YEAR
OF BIRTH

9. CARRIER

11. PORT OF ENTRY

12. DATE OF ENTRY

13. TERMINATION DATE OF
QUARANTINE

14. DATE REMOVED FROM
QUARANTINE STATION

FOR USE BY VS RIVERDALE, MD OFFICE - Record of Transfer
20. APPROVED ZOO (Name and address, include ZIP
Code)

25. APPROVED ZOO (Name and address, include ZIP
Code)

16. ENDORSEMENT

21. ENDORSEMENT

26. ENDORSEMENT

17. DATE OF ARRIVAL AT ZOO

22. DATE OF ARRIVAL AT ZOO

27. DATE OF ARRIVAL AT ZOO

18. SIGNATURE OF RESPONSIBLE OFFICIAL

23. SIGNATURE OF RESPONSIBLE OFFICIAL

28. SIGNATURE OF RESPONSIBLE OFFICIAL

19. LOCATION IN PARK

24. LOCATION IN PARK

29. LOCATION IN PARK

DATE

VS FORM 17-65C
DEC 2014

PEN NUMBER

DATE

PEN NUMBER

(Previous editions may be used)

DATE

PEN NUMBER

PERIODIC HEALTH INSPECTION

(Inspections to be made at least every 6 months - type or printdata, sign in ink)
DATE

VS FORM 17-65C (Reverse)

REMARKS

SIGNATURE
(Examining Veterinarian)

COPY DESIGNATIONS
LOWER RIGHT CORNER
IN BLACK INK

PART 1 - AREA OFFICE, RIVERDALE, MD

PART 2 - ZOO

PART 3 - RIVERDALE, MD OFFICE

PART 4 - VS AREA OFFICE