APHIS 7003A Application for New License

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 0579-0036. The time required
to complete this information collection is estimated to average .25 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.

OMB Approved
0579-0036
EXP: XX/XXXX

OFFICIAL USDA USE ONLY
SEND THE COMPLETED FORM TO:

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

APPLICATION FOR NEW LICENSE
LICENSE/
CUSTOMER NUMBER

(TYPE OR PRINT)

EXPIRATION DATE

AMOUNT

DATE RECEIVED

No license may be issued unless a completed application has been received and the applicant is in compliance with standards and regulations.
See 7 U.S.C. 2132-2143 and 9 CFR 2.

1. TYPE OF LICENSE:

Class A - Breeder

2. TYPE OF LEGAL ENTITY:

Individual

Class B - Dealer

Partnership

Firm

Class C - Exhibitor

Joint Stock Company

Corporation

Association

Trust

Estate

Other legal entity: _________________________________________________ 
3. NAME OF APPLICANT AND MAILING ADDRESS (see instructions):

4. ALL BUSINESS NAMES/LOCATIONS AND ADDRESSES HOUSING ANIMALS:
(Include directions to each location. P.O. Box is not acceptable.)
CHECK BOX IF ADDITIONAL LOCATIONS ARE LISTED ON AN ADDITIONAL SHEET

COUNTY:
TELEPHONE NUMBER:
PERSONAL RESIDENCE

COUNTY:
NOT A PERSONAL RESIDENCE

5. EMAIL (if applicable):

TELEPHONE NUMBER:
6. LIST YOUR 12 MONTH BUSINESS YEAR (calendar or fiscal):
FROM
MONTH

7. IF THE APPLICANT IS A CORPORATION, PARTNERSHIP, OR OTHER
BUSINESS ENTITY, LIST THE ENTITY’S PARTNERS OR OFFICERS AND
AGENT FOR SERVICE OF PROCESS.
CHECK BOX IF ADDITIONAL PERSONS ARE LISTED ON AN ADDITIONAL SHEET.

NAME

TO
DAY

MONTH

DAY

8. DEALERS ONLY - CLASS A OR CLASS B LICENSEES MUST COMPLETE
THIS BLOCK (9 CFR 2.6, 2.7) (Class C Licensees go to Block 10)
CLASS A (Breeder) – LINE D = ½ OF LINE C
CLASS B (Dealer) – LINE D = LINE C LESS AMOUNT PAID FOR THE ANIMALS

A. TOTAL NUMBER OF ANIMALS PURCHASED IN THE
PRECEDING BUSINESS YEAR

TITLE

B. TOTAL NUMBER OF ANIMALS SOLD IN THE
PRECEDING BUSINESS YEAR

9. (A) PREVIOUS USDA LICENSE NUMBER (if any):
(B) ACTIVE USDA LICENSE NUMBER IN WHICH YOU HAVE AN INTEREST:

C. GROSS DOLLAR AMOUNT DERIVED FROM
REGULATED ACTIVITIES (sales, commissions, etc.)

$

D. DOLLAR AMOUNT ON WHICH FEE IS BASED

$

10. EXHIBITORS ONLY (Class C Licensees) – THE
LARGEST NUMBER OF ANIMALS YOU HELD,
OWNED, LEASED, OR EXHIBITED AT ANY ONE TIME
DURING THE PREVIOUS BUSINESS YEAR.

TOTAL ONLY:

(9 CFR 2.6, 2.7)

CERTIFICATION
I certify the information provided herein is true and correct to the best of my knowledge. I hereby certify, to the best of my knowledge and belief, I am in compliance with, and
agree to continue to comply with, the regulations and standards in 9 CFR, Subpart A, Parts 1, 2, and 3. I certify that I am and all listed persons are 18 years of age or older.
11. SIGNATURE:

APHIS FORM 7003A
MAY 2018

12. PRINT NAME AND TITLE:

(Previous editions are obsolete.)

13. DATE:

Privacy Act Notice
Authority: The Animal Welfare Act (AWA), 7 U.S.C. 2131 et seq., and the regulations issued thereunder, 9 CFR parts 1 through 4; and the Horse
Protection Act (HPA), 15 U.S.C. 1821 et seq., and the regulations issued thereunder, 9 CFR parts 11 and 12.
Purpose: This system supports APHIS’ administrative activities and enforcement of the AWA and HPA.
Routine Uses:
In addition to those disclosures generally permitted under 5 U.S.C. 552a (b) of the Privacy Act, records maintained in the system may be disclosed outside
USDA as follows:
(1) APHIS may disclose the name, city, State, license or registration type and/or status, or change of a license or registrant to any person pursuant to 9 CFR
2.38(c) and 2.127;
(2) APHIS may disclose annual reports submitted to APHIS by licensees and research facilities to any person pursuant to 9 CFR 2.7 and 2.36;
(3) APHIS may disclose inspection reports and other regulatory correspondence issued to licensees and registrants [from the agency] to any attending
veterinarian in order to carry out duties under the AWA pursuant to 9 CFR 2.33 and 2.40;
(4) APHIS may disclose the name, telephone number and other contact information, location, inspection reports, and regulatory and other correspondence
of licensees, registrants, permitees, and applicants for the same, to appropriate Federal, foreign, State, local, Tribal, or other public authority agencies or
officials, in order to carry out duties under the AWA or State, local, Tribal or other public authority on the same subject pursuant to 7 U.S.C. 2145(b);
(5) APHIS may disclose inspection reports of licensees and registrants, and permit status, to any pet store or other entity that is required under State, local,
Tribal, or other public authority to verify a licensee, registrant, or permitee’s compliance with the AWA;
(6) APHIS may disclose information to the National Academies of Sciences, Engineering, and Medicine, and any other research institution engaged or
approved by the Department, to the extent APHIS deems the disclosure necessary to complete research and/or compile a report in furtherance of the
Department’s mission;
(7) APHIS may disclose final adjudicatory AWA and HPA decisions or orders by an appropriate authority to any person;
(8) APHIS may disclose to any person the name, city, and State or other information to the extent necessary for proper identification of persons (referred to
as “Designated Qualified Persons” or “DQPs”) that are or have been qualified to detect and diagnose a horse that is sore or otherwise inspect horses for
purposes of enforcing the HPA and of horse industry organizations or associations (referred to as “HIOs”) that have currently or have had in the past DQP
programs certified by the USDA;
(9) APHIS may disclose to any regulated horse owner, HIO, and other entities responsible for licensure or required to verify compliance with the HPA, HPA
inspection findings and regulatory and other correspondence issued to persons or entities regulated under the HPA;
(10) APHIS may disclose to any person the name, city, and State or other information to the extent necessary for proper identification of any person or entity
who has been disqualified, suspended, and/or otherwise prohibited from showing or exhibiting any horse, or judging or managing any horse show, horse
exhibition, horse sale, or horse auction under the HPA and the terms of such action;
(11) APHIS may disclose to any person the name, city, and State or other information to the extent necessary for proper identification of any regulated
individual or entity whose license or permit has been suspended, revoked, expired, terminated, or denied under the AWA and the terms of such action;
(12) APHIS may disclose to appropriate law enforcement agencies, entities, and persons, whether Federal, foreign, State, local, or Tribal, or other public
authority responsible for enforcing, investigating, or prosecuting an alleged violation or a violation of law or charged with enforcing, implementing, or
complying with a statute, rule, regulation, or order issued pursuant thereto, when a record in this system on its face, or in conjunction with other records,
indicates a violation or potential violation of law, whether civil, criminal, or regulatory in nature, and whether arising by general statute or particular program
statute, or by regulation, rule, or court order issued pursuant thereto, if the information disclosed is relevant to any enforcement, regulatory, investigative, or
prosecutive responsibility of the receiving entity;
(13) APHIS may disclose to the Department of Justice when the agency, or any component thereof, or any employee of the agency in his or her official
capacity, or any employee of the agency in his or her individual capacity where the Department of Justice has agreed to represent the employee, or the
United States, in litigation, where the agency determines that litigation is likely to affect the agency or any of its components, is a party to litigation or has an
interest in such litigation, and the use of such records by the Department of Justice is deemed by the agency to be relevant and necessary to the litigation;
provided, however, that in each case, the agency determines that disclosure of the records to the Department of Justice is a use of the information contained
in the records that is compatible with the purpose for which the records were collected;
(14) APHIS may disclose information in this system of records to a court or adjudicative body in administrative, civil, or criminal proceedings when: (a) The
agency or any component thereof; or (b) any employee of the agency in his or her official capacity; or (c) any employee of the agency in his or her individual
capacity where the agency has agreed to represent the employee; or (d) the United States Government, is a party to litigation or has an interest in such
litigation, and by careful review, the agency determines that the records are to be for a purpose that is compatible with the purpose for which the agency
collected the records;
(15) APHIS may disclose information from this system of records to appropriate agencies, entities, and persons when: (a) USDA suspects or has confirmed
that there has been a breach of the system of records; (b) USDA has determined that as a result of the suspected or confirmed breach there is a risk of harm
to individuals, USDA (including its information systems, programs, and operations), the Federal Government, or national security; and (c) the disclosure
made to such agencies, entities, and persons is reasonably necessary to assist in connection with USDA’s efforts to respond to the suspected or confirmed
compromise and prevent, minimize, or remedy such harm;
(16) APHIS may disclose information from this system of records to another Federal agency or Federal entity, when the USDA determines that information
from this system of records is reasonably necessary to assist the recipient agency or entity in (a) responding to a suspected or confirmed breach or (b)
preventing, minimizing, or remedying the risk of harm to individuals, the recipient agency or entity (including its information systems, programs, and
operations), the Federal Government, or national security, resulting from a suspected or confirmed breach;
(17) APHIS may disclose information in this system of records to USDA contractors and other parties engaged to assist in administering the program,
analyzing data, developing information management systems, processing Freedom of Information Act requests, and conducting audits. Such contractors
and other parties will be bound by the nondisclosure provisions of the Privacy Act;
(18) APHIS may disclose information in this system of records to USDA contractors, partner agency employees or contractors, or private industry employed
to identify patterns, trends, or anomalies indicative of fraud, waste, or abuse;
(19) APHIS may disclose information in this system of records to a Congressional office from the record of an individual in response to any inquiry from that
Congressional office made at the written request of the individual to whom the record pertains;
(20) APHIS may disclose information in this system of records to the National Archives and Records Administration or to the General Services
Administration for records management activities conducted under 44 U.S.C. 2904 and 2906; and
(21) APHIS may disclose information in this system of records to the Treasury Department as necessary to carry out any and all functions within their
jurisdiction, including but not limited to, processing payments, fees, collections, penalties, and offsets.
Disclosure: Furnishing this information is voluntary; however, failure to furnish this information may impede you’re a ability to comply with the requirements
of the Animal Welfare Act, regulations, and standards.

INSTRUCTIONS FOR COMPLETING APHIS FORM 7003A AND THE FEDERAL DEBT COLLECTION FORM APHIS Form 7030



Read all instructions before completing the application and Federal Debt Collection Form (APHIS Form 7030). Corrections and/or clarifications will
delay the processing of your application.






All blocks must be completed; if one does not apply enter “N/A” for not applicable.
Mail all original documents to the office. APHIS cannot accept applications that are copied, e-mailed, or faxed.
Include the application, tax identification sheet, and application fee of $10.00.
Payments can be made by check, money order, or credit card. Cash will not accepted.
COMPLETING THE FEDERAL DEBT COLLECTION FORM (APHIS Form 7030):

a. If an Individual, write the individual’s name and social security number (SSN) or employee identification number (EIN), as appropriate.
b. If a Partnership, write either all partners’ names and social security numbers or the business name and employee identification number.
c. If a Corporation, Firm, Joint Stock Company, Association, Trust, Estate or Other legal entity, write the business name and employee identification
number.
d. Must match what was selected under Block 2 of the application.
COMPLETING THE APHIS FORM 7003A:
Block 1:

Check a box to select only one type of license:
Class A (breeder) - sells only the offspring of animals bred and raised at your facility in a closed or stable colony and those animals
acquired for the sole purpose of maintain or enhancing the breeding colony.
Class B (broker) - buys and/or resells animals, including brokers and operators of auction sales, and may also exhibit animals as a minor
part of the business.
Class C (exhibitor) - shows or displays animals to the public, and may also buy and sell animals as a minor part of the business to
maintain or add to his or her animal collection.

Block 2:

Select the box that appropriately describes your type of organization:
Individual - Owner name only listed in Block 3.
Partnership - Either partners’ names or business name listed in Block 3. List the partners’ first and last name and title in block 7.
Firm - Firm’s name listed in Block 3. List the first and last name and title of all officers authorized to conduct business for the licensee in
block 7.
Joint Stock Company - Company’s name listed in Block 3. List the first and last name and title of all officers authorized to conduct
business for the licensee in block 7.
Corporation - Business’ name listed in Block 3. List the first and last name and title of all officers authorized to conduct business for the
licensee in block 7.
Association - Association’s name listed in Block 3. List the first and last name and title of all officers authorized to conduct business for the
licensee in block 7.
Trust - Trust’s name listed in Block 3. List the first and last name and title of all officers authorized to conduct business for the licensee in
block 7.
Estate - Estate’s name listed in Block 3. List the first and last name and title of all officers authorized to conduct business for the licensee in
block 7.
Other legal entity - Entity’s name listed in Block 3. List the first and last name and title of all officers authorized to conduct business for the
licensee in block 7.

Block 3:

List your applicant name and business mailing address.
This block cannot be left blank and can include only ONE address.
Applicant means the name that will appear on the license.
If applying as an Individual, put the individual’s legal name only.
If applying as a Partnership, either list all partners’ names or the business name.
If applying as Firm, Joint Stock Company, Corporation, Association, Trust, Estate, or Other legal entity, list the business name only.
Mailing Address refers to the address USDA will use to send all correspondence.
List the street address or post office box address, city, state, and ZIP code.
Insert the county/parish for the above listed mailing address.
Insert the telephone number for the applicant listed above.
Check the appropriate box for the personal residence box if the mailing address is a personal residence or if the mailing address is not a
personal residence (a personal residence is a location where the owners or anyone else resides at the facility).
NOTE: A new license may be needed if there are any changes to the name, address, type of business, or legal entity of your
business.

Block 4:

List the physical address of where the animals are located.
P.O. boxes cannot be listed in this block.
Address must be provided; cannot leave this block blank.
Check the box if additional locations are listed on an additional sheet.
List the additional locations on an additional sheet.
List the street address, city, state, and zip code for each location.
List the county for each location.

List the telephone number for the person to contact at that location.

Block 5:

If applicable, insert the email address for the applicant listed above. If you do not have one, enter N/A.

Block 6:

Insert your 12-month business year, either as a calendar year (January 1 to December 31) or fiscal year (October 1 to September 30).

Block 7:

Insert the first and last name and title of all officers authorized to conduct business for the licensee.
If applying as an Individual, leave empty.
If applying as a Partnership, list all partners’ names and titles.
If applying as Firm, Joint Stock Company, Corporation, Association, Trust, Estate, or Other legal entity, list the names and titles of
the partners or officers and agent for service of process.

Block 8:

Complete this block if applying for either Class A (breeder) or Class B (broker) License.
Class A (breeder)
a. Enter the total number of regulated animals purchased in the preceding business year.
b. Enter the number of regulated animals sold in the preceding business year.
c. Enter the gross dollar amount derived from regulated activities (sales, commissions, etc.).
d. Enter half the total amount of line C.
Class B (broker)
a. Enter the total number of regulated animals purchased in the preceding business year.
b. Enter the number of regulated animals sold in the preceding business year.
c. Enter the gross dollar amount derived from regulated activities (sales, commissions, etc.).
d. Enter the total dollar amount derived minus the amount paid for the purchased animals.
Please see the fee schedule for more information on how to complete this block.

Block 9:

(A) List all previous license numbers. In none, enter N/A.
(B) List all other active USDA license numbers in which you have in interest. If none, enter N/A.

Block 10:

Complete only if applying for Class C (exhibitor) license.
Enter the largest number of animals you held, owned, leased, or exhibited at any one time during the previous business year. The
total number will be used to determine the annual license fee.

Block 11:

Insert the signature of the authorized person listed in Block 3 or Block 7.
If applying as an Individual, the application has to be signed by the applicant as him or herself.
If applying as a Partnership, the application has to be signed by one of the partners as him or herself.
If applying as Firm, Joint Stock Company, Corporation, Association, Trust, Estate, or Other legal entity, a person listed in block 7
must sign the application.

Block 12:

Insert the first and last name of the authorized person signing the application.
The person who signs the form must be listed in either Block 3 or Block 7 of the application.

Block 13:

Insert the date the form is signed.