VS Form 9-2 Flock Selecting and Testing Report

OMB Approved 0579-0007

REPORT NO.

See reverse side for additional information.

SUBPART
B or G - Egg Type Chickens
UNITED STATES DEPARTMENT OF AGRICULTURE
C or H - Meat Type Chickens
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
D - Turkeys
NATIONAL POULTRY IMPROVEMENT PLAN
E - Hobbyist/Exhibition Poultry, Raised for
Release Waterfowl, Backyard Birds
FLOCK SELECTING AND
F - Ostrich, Emu, Rhea, Cassowary
I - Meat Type Waterfowl
TESTING REPORT
J - Egg/Meat Type Game Birds, Raised
for Release Game Birds
Other
1. Name and Address of Flock Owner (include ZIP Code)

S 000000

CLASSIFICATION - U.S.
Pullorum - Typhoid Clean
M. Gallisepticum Clean
M. Synoviae Clean
Sanitation Monitored
M. Meleagridis Clean
M.G. Monitored
M.S. Monitored

Salmonella Enteritidis Clean
Salmonella Enteritidis Monitored
Salmonella Monitored
Avian Influenza Clean
H5/H7 Avian Influenza Clean
H5/H7 Avian Influenza Monitored
Newcastle Disease Virus Clean
Other

2. Location of Flock

3. Date of Preceding Test – This Location

4. Supply Flock for: (Name and Address of Hatchery or Dealer – include ZIP Code)

NPIP Approval Number

5. Breed, Variety, Strain, or Trade Name of Stock

Age of Birds

6. Males (Source and Number)

Date of Hatch
a. Number of
Males Tested

Blood Testing

b. Number of
Females Tested

7. Females (Source and Number)
c. TOTAL
Number Tested

d. Number of
Reactors

Date of Hatch
e. Number Sent
to Laboratory

TYPE
Primary
Multiplier

Code Identification
8. Total Birds in Flock
f. Laboratory Findings

9. PULLORUM TYPHOID
10. M. GALLISEPTICUM
11. M. SYNOVIAE
12. AVIAN INFLUENZA
13. NEWCASTLE DISEASE
14. OTHER (specify)
AGREEMENT OF FLOCK OWNER

I agree to keep my poultry breeding stock segregated from other poultry and in
accordance with the provisions of the Plan and regulations of the official State Agency.
I further agree to flock inspection by a representative of the official State Agency as
prescribed by the provisions and regulations.

VS FORM 9-2 (MAR 2019)

Signature of Inspector or Authorized Agent

Date

Signature of Flock Owner

Date

Previous edition may be used.

PART 1 - OFFICIAL STATE AGENCY COPY

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 numbers for this information collection are 0579-0007 and 0579-0474. The time required
to complete this information collection is estimated to average 10 minutes 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 and 0474

This report is required by regulation (9 CFR 145). Failure to report can result in
non-classification of poultry and poultry products under the NPIP.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
NATIONAL POULTRY IMPROVEMENT PLAN

FLOCK SELECTING AND TESTING REPORT

REPORT NUMBERS FROM ______________________________

VS Form 9-2 (MAR 2019)

Previous edition may be used.

TO

_______________________________