VS 4-106 Field Investigation of Brucellosis Market Test Reactor(s

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
OMB APPROVED
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0047. The time required
0579-0047
to complete this information collection is estimated to average .50 hours per response, including the time for reviewing instructions, searching existing
EXP. XX/XXXX
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
1. MCT LOG (VS Form 4-100)
2. DATE INVESTIGATION STARTED
USDA – APHIS

FIELD INVESTIGATION OF BRUCELLOSIS
MARKET TEST REACTOR(S)

3. DATE BLED

4. PLACE BLED

5. NAME OF TESTING
LAB.

Slau.

STATE
6. BACKTAGGED

LOCATION
(A)

Page No.

NAME AND ADDRESS OF MARKET OR SLAUGHTER EST.

Mkt.
DATE

Book No.

(B)

BACK TAG NO.

7. NO. BACKTAGGED

(C)

EAR TAG NO.

SALES TAG NO.

DATE

(D)
OTHER IDENTIFICATION

(E)
PLATE
TEST

(F)
CARD
TEST

(L)
AGE

(N)
SCALE WT. (lb.)

(G)

OPTIONAL TESTS

REACTOR ANIMAL(S)

8.
9.
10.
(H)

(I)

SPECIES

BREED

(J)

(K)
SEX

COLOR

(M)
VAC. STATUS

(O)

LIVE WT. (lb.)

8.
9.
10.

TRACING TO ORIGIN

11. NAME AND ADDRESS OF CP CONSIGNOR

(A)

12. NAME AND ADDRESS OF OWNER (If different from consignor)

13. DATE OF LAST HERD INFECTION

14. DATE OF LAST MCT REACTOR

16. PERCENT OF HERD VACCINATED FOR BRUC.

HERD INFORMATION

(B)
NO. ANIMALS MOVED
WITH REACTOR

COUNTY

None

15. DATE OF LAST POSITIVE BRT

17. CLINICAL SIGNS OF BRUC. IN HERD
%

Yes

No

19. TYPE OF HERD

None

None
18. TIME REACTOR IN HERD

Unknown
20. CATTLE CENSUS ON PREMISES

A. COWS

Dairy

B. BULLS

C. STEERS

Beef
Both

E. HEIFERS 1-2 YEARS
(1) Vac.
(2) NV

22. HAS HERD BEEN QUARANTINED

21. HERD SCHEDULED FOR TEST
DATE

D. CALVES UNDER 12 MO.
(1) Vac.
(2) NV

DATE (If “Yes”)

BY
Yes

NO (If “No” explain fully in item 24.)

No

TRACKING EXPOSED ANIMALS

23. ANIMALS FROM THIS CONSIGMENT SOLD

(A)

NO. ANIMALS

24. REMARKS (Attach a separate sheet.)
25. INVESTIGATOR (Signature)

VS FORM 4-106
APR 2009

(B)

(E)

SOLD FOR

NAME AND ADDRESS OF BUYER

(C)

26. TITLE

SLAU.

(D) RETURN
TO FARM

27. DATE

IDENTIFICATION NO.
(Back tag, Sale tag, etc.)

Privacy Act Notice
Veterinary Services – Brucellosis Information System and Brucellosis Recording and Reporting System
Authority: 21 U.S.C. 111, 112, 114, 114a-1, 115, 120, 121, 125, 134a-134f and title 9, Code of Federal Regulations, part 51 and
part 78.
Purpose and Routine Uses:
Routine uses of records maintained in the system, including categories of users and the purposes of such uses:
1)
2)
3)
4)
5)
6)
7)

Detecting the foci of infection to reduce the rate of spread of infection to new herds;
Evaluating brucellosis program activities of State, Federal, and contractual personnel;
Preparing mailing labels and preaddressed forms to enhance field activities;
Evaluating program effectiveness;
Detecting factors of epidemiologic importance in containing or eliminating foci of infected herds;
Assuring that brucellosis indemnities are promptly and properly paid;
Notification of livestock owners with the animals at high risk of exposure to brucellosis because of livestock movements or
an outbreak of disease or presence of quarantined premises in a community;
8) Referral to the appropriate agency, whether Federal, State, local, or foreign, charged with responsibility of investigating or
prosecuting a violation of law concerning animal disease control and eradication, or of enforcing or implementing a
statute, rule, regulation, or order issued pursuant thereto, of any record within this system when information available
indicates a violation or potential violation of law concerning animal disease control and eradication, whether civil, criminal,
or regulatory in nature, and either arising by general statute or particular program statute, or by rule, regulation, or court
order issued pursuant thereto;
9) Litigation by 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, 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;
10) Use in a proceeding before a court or adjudicative body before which the agency is authorized to appear, 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 agency has agreed to represent the employee, or the United States,
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 agency determines that use of such records is relevant and necessary to the
litigation; provided, however, that in each case, the agency determines that disclosure of the records to the court is a use
of the information contained in the records that is compatible with the purpose for which the records were collected; and
11) Response to a request from a congressional office from the record of an individual made at the request of that individual.
To certain Federal and State animal health officials to conduct, analyze, and report on the progress of animal disease
control or surveillance programs.

Disclosure: Furnishing this information is voluntary; however, failure to furnish this information may impede brucellosis
eradication activities.

Form Copy Designations
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