VS Form 9-3 Report Of Sales Of Hatching Eggs, Chicks, And Poults

Clear Form
This report is requested by certain States for the interstate shipment of poultry products.
Failure to report may result in non-acceptance of shipment.

REPORT NUMBER

See reverse side for OMB information

OMB Approved
0579-0007

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

1. DATE OF SHIPMENT

REPORT OF SALES OF HATCHING EGGS, CHICKS, AND POULTS
2. NAME, PHYSICAL ADDRESS, AND PHONE NUMBER OF PURCHASER

3. NAME, PHYSICAL ADDRESS, AND PHONE NUMBER OF PRODUCER OR SHIPPER

4. NAME, PHYSICAL ADDRESS, AND PHONE NUMBER OF DESTINATION OF EGGS, CHICKS, AND/OR POULTS

M.S. Monitored

M.G Monitored

Other

Meat

Primary
Breeding
Stock

Eggs

Other

Meat

Other

Meat

Eggs

Males

Females

Straight-run

Other

Poults

Chicks

Multiplier
Breeding
Stock

10. CLASSIFICATION – U.S.

Pullorum
Typhoid Clean
M. Gallisepticum
Clean
M. Synoviae
Clean
M. Meleagridis
Clean
S. Enteritidis
Monitored
S. Enteritidis
Clean
Salmonella
Monitored
Sanitation
Monitored
Avian Influenza
Clean
H5/H7 AI
Monitored
H5/H7 AI
Clean

9.TYPE (INTENDED USE)

Eggs

8.SEX

Commercial
Production
Stock
Turkey Eggs

5. QUANTITY

6. VARIETY,
STRAINS,
OR TRADE
NAME

Chicken Eggs

7. PRODUCT

OTHER
(Specify)

11. REMARKS (Services performed on products in shipment, e.g., vaccination, beak trimming, dubbing, etc., but not necessarily certified by State Inspector)

12. SIGNATURE OF STATE INSPECTOR
This is to certify that the above name producer or shipper
is participating in the National Poultry Improvement Plan
VS FORM 9-3
FEB 2016

(Previous editions are obsolete)

13. 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 .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.

VS FORM 9-3 (Reverse)

This report is requested by certain States for the interstate shipment of poultry products.
Failure to report may result in non-acceptance of shipment.

REPORT NUMBER

See reverse side for OMB information

OMB Approved
0579-0007

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

1. DATE OF SHIPMENT

REPORT OF SALES OF HATCHING EGGS, CHICKS, AND POULTS
2. NAME, PHYSICAL ADDRESS, AND PHONE NUMBER OF PURCHASER

3. NAME, PHYSICAL ADDRESS, AND PHONE NUMBER OF PRODUCER OR SHIPPER

4. NAME, PHYSICAL ADDRESS, AND PHONE NUMBER OF DESTINATION OF EGGS, CHICKS, AND/OR POULTS

M.S. Monitored

Other

Meat

M.G Monitored

10. CLASSIFICATION – U.S.

Primary
Breeding
Stock

Eggs

Other

Meat

Other

Meat

Eggs

Males

Females

Straight-run

Other

Poults

Chicks

Multiplier
Breeding
Stock

Pullorum
Typhoid Clean
M. Gallisepticum
Clean
M. Synoviae
Clean
M. Meleagridis
Clean
S. Enteritidis
Monitored
S. Enteritidis
Clean
Salmonella
Monitored
Sanitation
Monitored
Avian Influenza
Clean
H5/H7 AI
Monitored
H5/H7 AI
Clean

9.TYPE (INTENDED USE)

Eggs

8.SEX

Commercial
Production
Stock
Turkey Eggs

5. QUANTITY

6. VARIETY,
STRAINS,
OR TRADE
NAME

Chicken Eggs

7. PRODUCT

OTHER
(Specify)

11. REMARKS (Services performed on products in shipment, e.g., vaccination, beak trimming, dubbing, etc., but not necessarily certified by State Inspector)

This is to certify that the above named producer or shipper
is participating in the National Poultry Improvement Plan.
This is to certify that the description and classification of
the products listed above are properly indicated.
VS FORM 9-3
FEB 2016

12. SIGNATURE OF STATE INSPECTOR

13. DATE

14. SIGNATURE OF STATE INSPECTOR

15. DATE

(Previous editions are obsolete)

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
NATIONAL POULTRY IMPROVEMENT PLAN
INSTRUCTIONS FOR USE OF VS FORM 9-3
REPORT OF SALES OF HATCHING EGGS, CHICKS, AND POULTS
This form is designed to cover certain sales made by National Plan hatcheries, dealers, and independent flock owners. Some States require this form to be used for some or all
shipments coming into the State. Some foreign countries and/or importing purchasers may require this form.
This form will only be furnished to participants in the National Poultry Improvement Plan.
Items 1 through 11 of the report should be completed by the producer or shipper. The first (white) and last (yellow) copies should be removed for distribution indicated, and the
two remaining copies should be sent promptly to the producer or shipper’s Official State Agency for verification of checked classifications, counter signature, and proper
distribution.
Item No.
1-4. - Self-explanatory
5. - Indicated number (not cases, boxes, or dozens) of each kind of product
6. - Use a separate line to identify each product by variety, strain, or trade name
7. - Product – Describe each product by inserting an “X” in one of the 5 columns
8. - Sex – Insert an “X” in one of the 3 columns, except for eggs
9. - Type-Insert an “X” in one of the 3 columns as follows:
Commercial Production Stock - Products (eggs or baby poultry) not intended to be used for breeding purposes
Multiplier Breeding Stock - Breeding stock whose progeny will be used for commercial egg or meat production or exhibition purposes and not intended for further reproduction
Primary Breeding Stock - Breeding stock whose progeny will be used for further reproduction
10. - Classification – Insert an “X” in the column for each National Poultry Improvement Plan classification for which the product is qualified
11. - Self-explanatory
12-13. - Signature of State Inspector and Date – May be signed prior to form being sent to participant
14-15. - Signature of State Inspector and Date – Should not be signed until classifications checked by participant are verified by State Inspector

VS FORM 9-3
FEB 2016