Form APHIS 453 APHIS 453 Program Site Tag Information Sheet

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 0579-0327. The time required
to complete this information collection is estimated to average .25 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
0579-0327
EXP: XX/XXXX

PROGRAM SITE TAG
INFORMATION SHEET

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
1. STATE

2. DATE

3. LOCATION ADDRESS (Include ZIP Code)

4. REQUESTOR

5. TELEPHONE NUMBER

6. TYPE OF TAG (check the appropriate box)

□ Backtag Cattle
□ Vaccination Tag
□ Backtag Swine
□ Reactor Tag BR
□ I/D Tag Cattle
□ Reactor Tag TB
□ I/D Tag Swine
□ Bangle Tag
□ Other
________________________________________________________________________________________________________
(specify)

7. SINGLE/DUPLICATE TAG

8. ASSIGNED LETTER CODE

9. ROLLOVER TAG

9A. ROLLOVER SEQUENCE (1 Roll/2 Roll) 9B. EXCLUSIONS (I, O, etc.)

9C. BEGIN WITH LETTERS

10. YEARLY USAGE (HDS sets)

11. MAXIMUM ISSUE PER ORDER

13. MAXIMUM ISSUE

□ Yes
□ No

14. REMAINING STOCK

□ Use Stock Until Depleted

□ Destroy Stock

15. OTHER

16. NEW NATIONAL STOCK NUMBER (NSN) (to be assigned)

APHIS FORM 453
APR 2014

12. GLUE CONTAINER

Old Stock Number _____________________________________