VS Fomr 9-6 Report Of Salmonella Isolations To NPIP Official State A

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 of this information collection is 0579-0007. 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.

OMB Approved
0579-0007
EXP: XX/XXXX

This report is required by Regulation 9 CFR Part 145. Failure to report will hinder investigation of disease to determine origin of the infection.
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
NATIONAL POULTRY IMPROVEMENT PLAN

1. LABORATORY ACCESSION NO.

REPORT OF SALMONELLA ISOLATIONS TO NPIP
OFFICIAL STATE AGENCIES
(This report is issued as an aid to the detection of sources of Salmonella infections
but does not imply responsibility or liability for the infection)
2. NAME AND LOCATION OF STOCK

3. BREED, VARIETY, OR CROSS

4. INTENDED USE OF FLOCK

5. PERSON SUBMITTING SPECIMENS

6. DATE OF SUBMISSION

Breeding

Non-breeding

7. REPORTED HATCHERY SOURCE

8. NO OF CHICKENS

9. NO. OF TURKEYS

SPECIMENS SUBMITTED
10. NAME AND NO. OF OTHER SPECIES

11. APPROXIMATE AGE

12. ISOLATIONS
Pullorum
13. SPECIFY OTHER SEROTYPE
Typhoid
Paralphold
14. REMARKS (Include any information which may aid in determining the source of infection)

15. NAME AND ADDRESS OF DIAGNOSTIC LABORATORY (Include ZIP Code)

16. REPORT SUBMITTED BY

VS Form 9-6
MAY 2009

17. DATE REPORT SUBMITTED