APHIS Form 2018 Request for Reference, Reagent, or Reagent Seed Material

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 0579-0013. The time required to complete this information collection is
estimated to average 0.1 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.
US DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
CENTER FOR VETERINARY BIOLOGICS

OMB Approved
0579-0013
EXP.: XX/XXXX

REQUEST FOR REFERENCE, REAGENT, OR

Submit to: USDA-APHIS-VS
Center for Veterinary Biologics
1920 Dayton Avenue, P.O. Box 844
Ames, IA 50010

REAGENT SEED MATERIAL

or email to [email protected]

REQUEST
1. REQUESTING FIRM'S NAME AND COMPLETE MAILING ADDRESS

2. U.S. VET BIOL LICENSE OR PERMIT NO.
3. PHONE NUMBER (required for shipping)

4. CONTACT EMAIL

5. REAGENT REQUESTED (as listed in CVB Reagent Catalog, one
item per form)

6. QUANTITY
REQUESTED

8. NAME OF COURIER

11. REMARKS

7. INTENDED USE OF REAGENT

9. COURIER ACCOUNT NUMBER (To charge shipping costs)

10. PERMIT TO RECEIVE INFECTIOUS SUBSTANCES ENCLOSED
YES
NOT APPLICABLE
12. NAME AND TITLE OF PERSON MAKING REQUEST

13. SIGNATURE

14. DATE SUBMITTED
(mm/dd/yyyy)

REPLY (FOR VET BIOLOGICS USE)
15. ITEM SHIPPED

17. REMARKS

A. LOT NUMBER
B. NUMBER OF CONTAINERS
C. VOLUME OF EACH CONTAINER
D. TOTAL VOLUME
16. SHIPPING TEMPERATURE
AMBIENT

COLD PACK

DRY ICE

18. NAME AND TITLE OF AUTHORIZING CVB OFFICIAL

19. SIGNATURE

21. REMOVED FROM INVENTORY BY

22. VERIFIED BY

23. SHIPPED BY

24. SHIPPING DATE

APHIS FORM 2018
APR 2016

PREVIOUS VERSIONS OBSOLETE

20. DATE AUTHORIZED

INSTRUCTIONS FOR APHIS FORM 2018

Completed requests may be submitted by mail or email:

This form is used to request biological references, reagents, or reagent
seed material supplied by APHIS for use in testing (9 CFR 113) of
veterinary biologics.

Mail:
USDA-APHIS-VS
Center for Veterinary Biologics
1920 Dayton Avenue, P.O. Box 844
Ames, IA 50010

Submit a separate form for each reagent requested. If additional
space is needed, attach additional sheets and refer to Item No.
1. REQUESTING FIRM’S NAME AND COMPLETE MAILING
ADDRESS
Enter the biologics manufacturer or affiliated establishment requesting
the reagent. Enter the address to which the reagents are to be
shipped. Do not use P.O. Boxes.
2. U.S. VETERINARY BIOLOGICS ESTABLISHMENT LICENSE OR
PERMIT NUMBER
Enter the biologics establishment identifier provided by APHIS.
3. PHONE NUMBER
Enter a contact phone number for any questions about the request or
shipment. A phone number is required for most couriers.
4. CONTACT EMAIL
Provide an email address to which questions about the request or
shipment may be directed.
6. REAGENT REQUESTED
Enter one reagent per form. Describe the reagent exactly as it is listed
in the CVB Reagents catalog
(www.aphis.usda.gov/animal_health/vet_biologics/publications/vb_
reagents_catalog.pdf).
6. QUANTITY REQUESTED
Enter the quantity of reagent requested. Quantities are limited. APHIS
reserves the right to amend the quantity provided.
7. INTENDED USE OF REAGENT
Specify how the reagent will be used. APHIS reagents are intended
solely for use in testing veterinary biologics.
8. NAME OF COURIER
Specify the courier service that should be used to ship the reagent.
9. COURIER ACCOUNT NUMBER
Requestors are responsible for reagent shipping costs. Provide an
account number to which shipping costs may be charged.
10. PERMIT TO RECEIVE INFECTIOUS SUBSTANCES ENCLOSED
Interstate movement of certain infectious biological substances
requires a US Veterinary Permit for the Importation and Transportation
of Controlled Material and Organisms and Vectors. The permit is
issued to the recipient of the shipment and must be provided with this
form for inclusion in this shipment. See www.aphis.usda.gov/permits
for details.
Shipments of select agents require APHIS/CDC Form 2. See
www.selectagent.gov for details.
11. REMARKS
Use this item for miscellaneous information or instructions regarding
your request.
12 and 13. NAME AND TITLE OF PERSON MAKING REQUEST/
SIGNATURE
Self-explanatory items
14. DATE SUBMITTED
Enter the date that the request form is forwarded to APHIS.

Email: [email protected]

15-24. These items are for APHIS-Vet Biologics use only.
Recipients are asked to verify that the quantity received matches the
amount listed in Item 15 and that the reagent remains in the
temperature range specified in Item 17.
If reagents are damaged or if cold/frozen reagents have warmed,
please contact the Center for Veterinary Biologics at
(515) 337-6100 or [email protected].