APHIS 7005 Record of Acquisition of Dogs and Cats On Hand

Clear Form
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 numbers for this information collection are 0579-0036 and 0579-0392. The time required to complete this information collection is estimated to average 2 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 and 0579-0392

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

RECORD OF ACQUISITION OF DOGS AND CATS ON HAND
This record is required by law (7 U.S.C. 2131-2156). (9 CFR, Subchapter A, Parts 1, 2, and 3). Failure to maintain this record can result in a suspension or revocation of license and/or imprisonment for not more than 1 year, or a fine
of not more than $1,000, or both.
1. RECORD FOR (“X”)

USDA LICENSE OR
REGISTRATION NUMBER

Dealer

Holding Facility (Submit copy to Dealer)

Other

Exhibitor (Dogs and Cats only)

2. NAME AND ADDRESS OF LICENSEE, REGISTRANT, OR HOLDING
FACILITY

IDENTIFICATION OF EACH ANIMAL BEING DELIVERED (See reverse for Breed Abbreviations)
A.
TATTOO OR
USDA TAG NUMBR

B.

C.

DOG

CAT
“X”
M OR F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

D.

E.

AGE OR
DATE OF
BIRTH

WT.

F.

G.

BREED OR
TYPE *
(If mixed breed,
list two dominant
breeds)

LAST INSPECTION (Date)

APHIS 7005
JUL 2009
INSPECTOR USE
ONLY

TOTAL NUMBER ANIMALS ENTERED
SINCE LAST INSPECTION

TO (Mo., Day, Yr.)

ACQUIRED FROM
H.

DESCRIPTION OF ANIMAL
(Color, Distinctive Marks, Hair, Tail,
Tattoos, etc.)

3. BUSINESS YEAR
FROM (Mo., Day, Yr.)

I.

J.
NAME AND ADDRESS,
USDA LICENSE OR REGISTRATION NUMBER,
OR DRIVER’S LICENSE NUMBER AND STATE,
VEHICLE LICENSE NUMBER AND STATE

DATE
ACQUIRED

COUNT TOTAL NUMBER
ANIMALS ACTUALLY ON
PREMISES

Previous edition may be used. Replaces VS 18-5 which may be used.

DIFFERENCE (+ OR -)

4. PAGE
NUMBER

DISPOSITION
K.

DATE
REMOVED
OR SOLD

DATE
DIED OR
EUTHANIZED
(Specify)

DATE

INITIALS

BREED ABBREVIATIONS – DOGS (Column F)

Afghan Hound
Airedale Terrier
Akita
American Bull Terrier
Basenji
Basset Hound
Beagle
Bedlington Terrier
Bichon Frise
Black and Tan
Coonhound
Bluetick
Boston Terrier
Boxer
Bullmastiff
Cairn Terrier
Catahoula
Chihuahua
Chinese Crested Dog
Chow-Chow
Cocker Spaniel
Collie
Coonhound (Specify)

-

AH
AD
AK
AB
BS
BH
BE
BL
BF
BT

-

BK
BO
BX
BM
CT
CU
CA
CD
CC
CK
CL
CH

Dachshund
Dalmatian
Doberman
Elkhound
English Bulldog
English Setter
Eskimo Dog
Foxhound
Fox Terrier
French Bulldog
German Shepherd
German Short Haired
Pointer
Golden Retriever
Gordon Setter
Great Dane
Great Pyrenees
Greyhound
Husky
Irish Setter
Jack Russell Terrier
Keeshond
King Charles Spaniel

-

DH
DL
DB
EH
EB
ES
ED
FH
FT
FB
GS
SH

-

GR
GO
GD
GP
GH
HK
IS
JR
KH
KC

Komondor
Labrador Retriever
Lhasa Apso
Malamute
Mastiff
Maltese
Miniature Pinscher
Newfoundland
Old English Sheepdog
Pekingese
Pomeranian
Poodle
Pug
Redbond Coonhound
Rhodesian Ridgeback
Rottweiler
Saint Bernard
Samoyed
Schipperkee
Schnauzer
Scottish Terrier
Shar-pei
Shetland Sheepdog

BREED ABBREVIATIONS – CATS (Column F)

Abyssinian
Burmese
Domestic Long Hair
Domestic Short Hair
Himalayan
Maine Coon

APHIS 7005 (REVERSE)
JUL 2009

-

AB
BU
DL
DS
HM
MC

Manx
Persian
Russian Blue
Rex
Siamese
Other (Specify)

-

MX
PR
RB
RE
SI

-

KM
LR
LA
MM
MA
MT
MP
NF
OE
PK
PM
PO
PU
RB
RR
RW
SB
SM
SK
SN
SC
SP
SS

Shih-tzu
Silky Terrier
Spitz
Springer Spaniel
Staffordshire Bull
Terrier
Walker
Weimaraner
Welsh Corgi
Whippet
Yorkshire Terrier
Other (Specify)

-

SI
ST
SZ
SR
SA

-

WK
WI
WC
WH
YT

TYPE (Column F)

Hound Crossbreed
Terrier Crossbreed
Shepherd Crossbreed
Spaniel Crossbreed

-

HX
TX
SX
PX

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.