VS Form 9-2 Flock Selecting And Testing Report

OMB Approved 0579-0007

See reverse side for additional information.

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

REPORT NO.

R

CLASSIFICATION - U. S.
☐ Pullorum - Typhoid Clean
☐ M. Gallisepticum Clean
☐ M. Synoviae Clean
☐ Sanitation Monitored
☐ M. Meleagridis Clean
☐ M.G. Monitored
☐ M.S. Monitored

TYPE
☐
☐
☐
☐
☐
☐
☐

Salmonella Enteritidis Clean
Salmonella Enteritidis Monitored
Salmonella Monitored
Avian Influenza Clean
H5/H7 Avian Influenza Clean
H5/H7 Avian Influenza Monitored
Other

☐ 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
6. Males (Source and Number)

Blood Testing

a. Number of
Males Tested

Age of Birds

Date of Hatch

7. Females (Source and Number)

b. Number of
Females Tested

c. TOTAL
Number Tested

d. Number of
Reactors

Code Identification

Date of Hatch
e. Number Sent
to Laboratory

8. Total Birds in Flock

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.
VS FORM 9-2 (APR 2015)

Previous edition may be used.

Signature of Inspector or Authorized Agent

Date

Signature of Flock Owner

Date

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
0579-0007. The time required to complete this information collection is estimated to average .16 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
non-classification of poultry and poultry products under the NPIP.

OMB Approved
0579-0007

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
NATIONAL POULTRY IMPROVEMENT PLAN

FLOCK SELECTING AND TESTING REPORT

REPORT NUMBERS FROM _________________________________________

VS Form 9-2 (APR 2015)

Previous edition may be used.

TO

________________________________________