VS Form 17-140B Continuation Sheet for U.S. Origin Health Certificate

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 is 0579-0020. The time required to complete this information collection is estimated to average .5 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.
READ INSTRUCTIONS FROM VS FORM 17-140
This certificate is authorized by law (21 U.S.C. 112), while you are not required to respond, no health certificate can be validated unless the data requested is provided.
UNITED STATES DEPARTMENT OF AGRICULTURE
1. FIRST CONSIGNOR’S NAME (last name, first name, middle initial, or business name)
2. CERTIFICATE
MARKETING AND REGULATORY PROGRAMS
NUMBER FROM VS
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
FORM 17-140
VETERINARY SERVICES
16. CONSIGNEE’S NAME

CONTINUATION SHEET FOR
UNITED STATES ORIGIN HEALTH CERTIFICATE
STATEMENTS/CERTIFICATIONS

VS Form 17-140B
JAN 2011

OMB Approved
0579-0020
Exp.: XX/XXXX

3. PAGE NUMBER

OF