VS Form 17-30 REPORT OF ANIMALS, POULTRY, OR EGGS OFFERED FOR IMPORTAT

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 0579-0228. The time
required to complete this information collection is estimated to average 1 hour 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.
HEALTH CERTIFICATE NO.

DOCUMENT NO.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
VEHICLE LICENSE NO.

PERMIT NO.

REPORT OF ANIMALS, POULTRY, OR EGGS OFFERED FOR IMPORTATION
SEAL NO.

ALT NO.
NUMBER

OMB Approved
0579-0228
Exp.: 12/31/2015

CBP CODE
UNIT OF MEASURE

SPECIES

BREED

TYPE

AGE

SEX

PURPOSE OF IMPORTATION

*PORT OF ENTRY
COUNTRY OF ORIGIN
IMPORTER
**FOR DELIVERY TO
LOCATED AT
CERTIFICATE OF INSPECTION OF ANIMALS, POULTRY, OR EGGS OFFERED FOR IMPORTATION
This is to certify that I have inspected the listed animals, poultry, or eggs offered for importation for the purpose reported above, have found them to be free of evidence of
communicable diseases or exposure thereto, and otherwise have met all other applicable provisions of 9 CFR Part 92, as amended.
REMARKS

DATE OF ISSUANCE

VETERINARY INSPECTOR

*(As obtained from the importer or the importer’s agent)
**(Shipment not to be diverted without permission of port veterinarian)
VS FORM 17-30
Previous editions are obsolete
SEPT 2009