APHIS Form 2018 Request for Reference, Reagent, or Reagent Seed Material

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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 0579-0013. The time required to complete this information collection is
estimated to average 0.1 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.
US DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECT10N SERVICE
VETERINARY SERVICES
CENTER FOR VETERINARY BIOLOGICS

OMB Approved
0579-0013
EXP: 02/2022

REQUEST FOR REFERENCE, REAGENT,

Submit to: USDA-APHIS-VS
Center for Veterinary Biologics
1920 Dayton Avenue, P.O. Box 844
Ames, IA 50010

OR REAGENT SEED MATERIAL

or email to [email protected]

REQUEST
1. REQUESTING FIRM'S NAME AND COMPLETE MAILING ADDRESS

2. U.S. VET BIOLOGIC LICENSE OR PERMIT NO.

3. PHONE NUMBER (required for shipping)

4. CONTACT EMAIL

5. REAGENT REQUESTED (as listed in CVB Reagent Catalog, one item per
form)

6. QUANTITY
REQUESTED

8. NAME OF COURIER

11. REMARKS

7. INTENDED USE OF REAGENT

9. COURIER ACCOUNT NUMBER (to charge shipping costs)

10. PERMIT TO RECEIVE INFECTIOUS SUBSTANCES ENCLOSED
YES

NOT APPLICABLE

12. NAME AND TITLE OF PERSON MAKING REQUEST

13. DATE SUBMITTED
(mm/dd/yyyy)

REPLY (FOR VETERINARY BIOLOGICS USE)
14. ITEM SHIPPED

16. REMARKS:

A. LOT NUMBER
B. NUMBER OF CONTAINERS:
C. VOLUME OF EACH CONTAINER:
D. TOTAL VOLUME.
15. SHIPPING TEMPERATURE:
AMBIENT

COLD PACK

DRY ICE

17. NAME AND TITLE OF AUTHORIZING CVB OFFICIAL

18. SIGNATURE

20. REMOVED FROM INVENTORY BY

21. VERIFIED BY

22. SHIPPED BY

23. SHIPPING DATE

APHIS FORM 2018
AUG 2017

PREVIOUS VERSIONS OBSOLETE

19. DATE AUTHORIZED
(mm/dd/yyyy)

INSTRUCTIONS FOR APHIS FORM 2018
This form is used to request biological references, reagents, or reagent
seed material supplied by APHIS for use in testing (9 CFR 113) of
veterinary biologics.
Submit a separate form for each reagent requested. If additional
space is needed, attach additional sheets and refer to Item No.
1. REQUESTING FIRM’S NAME AND COMPLETE MAILING
ADDRESS
Enter the biologics manufacturer or affiliated establishment requesting
the reagent. Enter the address to which the reagents are to be
shipped. Do not use P.O. Boxes.

Completed requests may be submitted by mail or email:
Mail:
USDA-APHIS-VS
Center for Veterinary Biologics
1920 Dayton Avenue, P.O. Box 844
Ames, IA 50010
Email: [email protected]
14-23. These items are for APHIS-Veterinary Biologics use only.

2. U.S. VETERINARY BIOLOGICS ESTABLISHMENT LICENSE OR
PERMIT NUMBER
Enter the biologics establishment identifier provided by APHIS.

Recipients are asked to verify that the quantity received matches the
amount listed in Item 14 and that the reagent remains in the
temperature range specified in Item 15.

3. PHONE NUMBER
Enter a contact phone number for any questions about the request or
shipment. A phone number is required for most couriers.

If reagents are damaged or if cold/frozen reagents have warmed,
please contact the Center for Veterinary Biologics at
(515) 337-6100 or [email protected].

4. CONTACT EMAIL
Provide an email address to which questions about the request or
shipment may be directed.
5. REAGENT REQUESTED
Enter one reagent per form. Describe the reagent exactly as it is listed
in the CVB Reagents catalog
(www.aphis.usda.gov/animal_health/vet_biologics/publications/vb_
reagent_catalog.pdf).
6. QUANTITY REQUESTED
Enter the quantity of reagent requested. Quantities are limited. APHIS
reserves the right to amend the quantity provided.
7. INTENDED USE OF REAGENT
Specify how the reagent will be used. APHIS reagents are intended
solely for use in testing veterinary biologics.
8. NAME OF COURIER
Specify the courier service that should be used to ship the reagent.
9. COURIER ACCOUNT NUMBER
Requestors are responsible for reagent shipping costs. Provide an
account number to which shipping costs may be charged.
10.
PERMIT TO RECEIVE INFECTIOUS SUBSTANCES
ENCLOSED Interstate movement of certain infectious biological
substances requires a US Veterinary Permit for the Importation and
Transportation of Controlled Material and Organisms and Vectors. The
permit is issued to the recipient of the shipment and must be provided
with this form for inclusion in this shipment.
See www.selectagents.gov for details.
Shipments of select agents require APHIS/CDC Form 2. See
www.selectagents.gov for details.
11. REMARKS
Use this item for miscellaneous information or instructions regarding
your request.
12. NAME AND TITLE OF PERSON MAKING REQUEST
Self-explanatory items
13. DATE SUBMITTED
Enter the date that the request form is forwarded to APHIS.