Form VS 1-64 VS 1-64 Manufacturer Application for Approval of Official Animal

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 OMB
control number for this information collection is 0579-0327. The time required to complete this information
collection is estimated to average 15 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.

UNITED STATES DEPARTMENT OF
AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION
SERVICE
VETERINARY SERVICES

OMB
Approved
0579-0327
EXP.:
XX/XX/XXXX

MANUFACTURER APPLICATION
FOR APPROVAL OF OFFICIAL
ANIMAL IDENTIFICATION
DEVICES

Submission of this form by a device manufacturer indicates that they agree to follow the procedures for
approval of official animal identification methods and devices contained in the Animal Disease Traceability
(ADT) General Standards document and submit all required supporting documentation (see ADT General
Standards Part C. Approval of Official Identification Methods and Devices for Animals and the associated
appendices, and 9 CFR 79.3(k) for sheep and goats). For more information on ADT and official identification
devices visit the ADT Website at http://www.aphis.usda.gov/traceability/.

Purpose of Application
☐ Initial
(Proposed field trial
protocol attached)

☐ Final
(Device approval and sales data
from other countries OR field trial
summary report attached)

☐ Modification of an approved device
(Original and proposed specifications, field trial data
and/or approval and sales data from other countries (as
applicable) attached)

Device Applicant Information
Name:

Nonproducer Participant Number (NPN):

Street Address :
Street Address 2:
City:
Phone:

State:
Email:

Primary Contact First Name:
Phone:

Postal Code:

Last Name:
Phone 2:

Email:

Do you plan to be a device/tag manager? (Distribute the approved device)

☐ Yes

What is the company’s role regarding this device?
☐ Complete manufacturing,
☐ Encoding and/or Imprinting only
imprinting, and encoding (Radio
Frequency Identification (RFID only))
What is the bi-weekly production capacity for this device?

☐ No

☐ US Device Manager only (foreign
manufacturer)

What is the anticipated inventory for this device?

Manufacturing Plant Information (if different than above)

NOTE: If more than one manufacturer provide additional contact information and locations on a separate
sheet
Business Name:

NPN:

Street Address:
Street Address 2:
City:
Country:

State:

Postal Code:

Phone:

Email:

Primary Contact First Name:
Phone:

VS Form 1-64
June 2019

Last Name:
Phone 2:

Email:

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What is the bi-weekly production capacity for this device?
What is the anticipated inventory for this device?

Device Information
NOTE: If requesting a modification to an existing approved identification device complete the
information below with the new device specifications.
Manufacturer Product
Code:
Required International Committee for Animal Recording (ICAR) Conformance and Performance
certifications attached:
ICAR Product code:
ICAR Approval date:
Device Name:

☐ Eartag

Device Format:

Physical Characteristics:
Shape:

☐ Round

Primary Material:

☐ Injectable transponder
☐ One Piece

☐ Rectangle

☐ Strip

☐ Yes

☐ No

☒Yes

☐ No

☐ Other (describe):
☐ Two Piece

☐ Other (describe):

High resolution pictures and diagrams showing all aspects of the device including materials used
in each component and measurements (including pictures of all print formats and colors for which
approval is requested for sheep and goats tags) emailed to [email protected].

Species
NOTE: USDA reserves the right to approve methods of identification specific to each species.
Additionally, the use of injectable transponders in food animals is subject to FDA and FSIS regulations.
Injectable transponders are not an approved official identification method for bison and cattle.
☐ Alpaca/Llama

☐ Cattle/Bison

☐ Deer/Elk

☐ Horses

☐ Sheep/Goats

☐ Swine

Device Details
☐ Low Frequency (LF) 134.2 kHz (must conform to ISO 11784 and 11785)
Technology type: ☐ HDX
☐ FDX
☐ UHF
Numbering Format: ☐ Animal Identification Number (AIN)
☐ National Uniform Eartagging System (NUES)
☐ Dual (combined low and ultra-high) Frequency Eartag (AIN Numbering format only)
☐ Visual Only
For technologies other than RFID: Please contact ADT Program Staff at traceability@usda,gov

Performance and Quality Controls
I certify that the identification device submitted for approval meets all performance and conformance
requirements as defined in the ADT General Standards

☐ Yes

☐ No

Description of the quality control measures detailing the ability to produce and distribute the device
consistently and according to the specifications contained in the ADT General Standards including,
the full quality control plan and flow diagram for this identification device from manufacturing of all
components, encoding and/or imprinting, shipment and addressing consumer complaints attached. If
more than one company is involved with the manufacturing of the device components a full quality
control plan is attached for the entity that performs each step and their location.

☐ Yes

☐ No

If requesting approval for a sheep and goat identification device, a signed Company Agreement for
Approval to Produce Official Eartags for Sheep and Goats is attached

☐ Yes

☐ No

VS Form 1-64
June 2019

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