VS Form 9-5 Report Of Hatcheries, Dealers, And Independent Flocks Pa

Clear Form
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 .5 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.

OMB Approved
0579-0007
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This report is required by Memorandum of Understanding. Failure to report can result in publication of inaccurate and/or incomplete information for the NPIP.
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE

REPORT OF HATCHERIES, DEALERS, AND INDEPENDENT
FLOCKS PARTICIPATING IN THE NPIP

STATE:

DATE SUBMITTED:

SUBMITTED BY:

IMPORTANT: Read instruction on reverse.
NAMES AND ADDRESSES OF PARTICIPANTS
(List alphabetically by Subpart, and give complete mailing address of each,
including ZIP Code)

VS Form 9-5
JUN 2009

SUBPART OF TYPE OF
POULTRY

EGG CAPACITY OR TYPE
OF DEALER

PRODUCTS CLASSIFIED “U.S. PULLORUMTYPHOID CLEAN”

ADDITIONAL
CLASSIFICATIONS FOR
WHICH THESE
PRODUCTS QUALIFY

INSTRUCTIONS
1. Prepare in duplicate. The original copy of the complete report should be submitted to the Poultry Improvement Staff, Building 265, BARC – East, Beltsville, MD, 20705, as
changes occur in participation. These reports will be used in preparing supplements to publication APHIS 91-41 and 91-42. The duplicate copy should be retained in the office of
the Official State Agency.
2. List participants alphabetically, by Subparts, wit compete mailing address of each participant, including ZIP Code.
3. Subpart of Type of Poultry – Indicate Subparts for which participant’s products are qualified, as follows:
B
- Egg Type Chickens
C
- Meat Type Chickens
D
- Turkeys
E
- Waterfowl, Exhibition Poultry, and Game Birds
4. For hatcheries – the egg capacity should include both incubating and hatching capacity. For dealers – use this column to indicate the type of products each dealer offers for sale
with the following codes. Leave column blank for Independent Flocks.
E
- Hatching Egg Dealer
C
- Chick Dealer
E and C - Dealer in both hatching eggs and chicks
P
- Poult dealer
E and P - Dealer in both hatching eggs and poults
5. List the code for the breed or variety (including strain and trade names) of products handled in column “Products Classified, U.S. Pullorum-Typhoid Clean.” The codes which
were published in the tables of stock codes in the latest revision of publication APHIS 91-41 should be used. Stocks not included in the tables should be assigned a code by the
reporting Official State Agency and the code explained on a supplementary sheet.
Crosses should be designated by combining the code letters and numbers of the stocks involved, indicating the variety of the male first. Fro example, b1c2 would indicate Arbor
Acres Rhode Island Red males mated to Colonial Barred Plymouth Rock females.
6. Additional disease and breeding classification for the individual products handles should be indicated in the “Additional classification For Which These Products Qualify” column.
For those products that have additional disease classification as well as a breeding classification, always list the disease classification first. The following abbreviation should be
used for these additional classifications:
MG
- U.S. M.Gallispeticum Clean
MS
- U.S. M. Synoviae Clean
App
- U.S. Approved
None
- No Classification other than U.S. Pullorum-Typhoid Clean
The following is an example of a report for one hatchery:
NAMES AND ADDRESSES OF PARTICIPANTS
(List alphabetically by Subpart, and give complete mailing address of each,
including ZIP Code)
Abbotts Quality Hatcher, 221 Sate Street, Anytown 60606

VS Form 9-5 (Reverse)
JUN 2009

SUBPART OF TYPE OF
POULTRY
C

EGG CAPACITY OR TYPE
OF DEALER
10,000

PRODUCTS CLASSIFIED “U.S. PULLORUMTYPHOID CLEAN”
t9tl,t17t20

ADDITIONAL
CLASSIFICATIONS FOR
WHICH THESE
PRODUCTS QUALIFY
MG, MS