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 0579-0101. The time required to complete this information collection is estimated to average 1 hour 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. |
OMB APPROVED 0579-0101 EXP DATE XX/XXXX |
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UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES |
APPLICATION FOR SCRAPIE CLASSIFICATION, CLASSIFICATION RENEWAL, OR RECLASSIFICATION OF A STATE |
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1. STATE |
2. OR AREA SMALLER THAN A STATE1. STATE 2. 1. STATE
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CONSISTENT STATUS |
3. APPLICATION FOR (“X” one) |
REINSTATEMENT OF CONSISTENT STATUS |
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RENEWAL OF CONSISTENT STATUS |
STAGE ONE STAGE TWO |
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4. QUALIFICATION (“X” all that apply) A. Check one of the following two qualification statements |
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The requirements of 9 CFR 79.6 have been met. The State effectively enforces a State designed scrapie program that is at least as effective in controlling scrapie as the requirements of 9 CFR Part 79 section 79.6. State program standards, legal authorities, and other supporting documentation are attached. (The supporting documentation must include which requirement(s) of 79.6 are not being met and the alternate methods being used.) |
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B. The Scrapie National Generic Database is continuously updated and all the data is accurate and complete for the reporting period. C. I have reviewed the RSSS report for the reporting period and it is accurate and correct. |
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STATE |
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5. FLOCK AND HERD POPULATION OF STATE |
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Boxes A-F should only be completed if the State collects statistics that they believe are more accurate than NASS. If the State wants APHIS to use NASS as the source for this State’s statistics, please write “NASS” in box 6 and leave boxes 5A-F and box 7 blank. |
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A. TOTAL NO. SHEEP FLOCKS |
B. TOTAL NO. GOAT HERDS |
C. NO OF BREEDING SHEEP |
D. NO. OF BREEDING GOATS |
E. TOTAL NO. OF SHEEP |
F. TOTAL NO. OF GOATS |
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6. DETERMINED BY |
7. REPORT DATES |
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A. FROM |
B. TO |
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IDENTIFICATION OF ANIMALS |
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8. Percent of breeding animals identified as required in 9 CFR 79.2 |
9. Percent of slaughter animals over 18 months identified as required in 9 CFR 79.2 |
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10. Method of determination |
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11. Owners were notified in accordance with 9 CFR Part 79.4(c) Yes No (Explain any exceptions.)(If more space is needed, use an attachment sheet.) |
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12. REMARKS
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CERTIFICATION |
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The provisions of 9 CFR Parts 54 and 79 have been met. We request that this State be declared Consistent. |
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13. Signature of State Official |
14. Please Type or Print Name |
15. Date |
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16. Signature of Federal Veterinarian in Charge |
17. Please Type or Print Name |
18. Date |
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19. Renewal approval by VS Region |
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Renewal is Approved Renewal is Not Approved Renewal is Approved Once the Following Conditions have been met: |
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20. Signature of Regional Epidemiologist |
21. Please Type or Print Name |
22. Date |
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23. Veterinary Services hereby declares the above State Consistent for the period beginning _____________________________and ending___________________________
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24. Signature of Certifying Official
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25. Please Type or Print Name |
26. Date
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VS FORM 5-24
APR 2010
File Type | application/msword |
File Title | According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond |
Author | Khbrown |
Last Modified By | smharris |
File Modified | 2011-12-15 |
File Created | 2010-02-17 |