VS 1-64 Manufacturer Application for Approval of Official Animal

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 OMB control number for this information collection is 0579-0327. The time required to complete this information collection is
estimated to average 15 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB Approved
0579-0327
EXP: XX/XXXX

MANUFACTURER APPLICATION
FOR APPROVAL OF
OFFICIAL ANIMAL IDENTIFICATION DEVICES

Submission of this form by a device manufacturer indicates that they agree to follow the procedures for approval of official animal
identification methods and devices contained in the Animal Disease Traceability (ADT) General Standards document and submit all required
supporting documentation (see ADT General Standards Part C. Approval of Official Identification Methods and Devices for Animals and the
associated appendices, and 9 CFR 79.3(k) for sheep and goats). For more information on ADT and official identification devices visit the ADT
Website at http://www.aphis.usda.gov/traceability/.

PURPOSE OF APPLICATION
Initial

Final

Modification of an approved device

Please refer to the Animal Disease Traceability Official Animal Identification Device Standards, Section C: Approval of Official Identification Methods and Devices, and
supporting appendices for information on what to include in the application packet.

DEVICE APPLICANT INFORMATION
Name:

Premises Identification Number (PIN):

Street Address:
Street Address 2:
City:

State:

Phone:

Email:

Primary Contact First Name:

Last Name:

Phone:

Phone 2:

Postal Code:

Email:

Do you plan to be a device/tag manager? (Distribute the approved device)
Yes

No

What is the company’s role regarding this device?
Complete manufacturing, imprinting, and encoding
(radio frequency identification (RFID) only)

Encoding and/or Imprinting only

U.S. Device Manager only (foreign manufacturer)

What is the bi-weekly production capacity for this device?
What is the anticipated inventory for this device?

MANUFACTURING PLANT INFORMATION (if different than above)

(If more than one manufacturer, provide additional contact information and locations on a separate sheet)

Business Name:

Premises Identification Number (PIN):

Street Address:
Street Address 2:
City:

State:

Phone:

Email:

Primary Contact First Name:

Last Name:

Phone:

Phone 2:

What is the bi-weekly production capacity for this device?
What is the anticipated inventory for this device?

VS FORM 1-64
FEB 2022

Email:

Postal Code:

Country:

DEVICE INFORMATION

(If requesting a modification to an existing approved identification device, complete the information below with the new device specifications.)

Device Name:

Manufacturer Product Code:

Required International Committee for Animal Recording (ICAR) Conformance and Performance certifications attached?
ICAR Product Code:
Device Format:
Physical Characteristics:
Shape:

Yes

No

ICAR Approval Date:
Eartag

Injectable Transponder

Type:

One Piece

Two Piece

Round

Rectangle

Strip

Other (describe):

Other (describe):

Primary Material:
High resolution pictures and diagrams showing all aspects of the device including materials used in each component and
measurements (including pictures of all print formats and colors for which approval is requested for sheep and goats tags)
emailed to [email protected]?

Yes

No

SPECIES

(USDA reserves the right to approve methods of identification specific to each species. Additionally, the use of injectable transponders in food animals is subject to FDA and FSIS regulations.
Injectable transponders are not an approved official identification method for bison and cattle.)

Cattle/Bison

Deer/Elk

Horses

Sheep/Goats

Swine

DEVICE DETAILS
Low Frequency (LF) 134.2 kHz (must conform to ISO 11784 and 11785)
Technology type:

HDX

FDX

UHF
Numbering Format:

Animal Identification Number (AIN)

National Uniform Eartagging System (NUES)

Dual (combined low and ultra-high) Frequency Eartag (AIN Numbering format only)
Visual Only
For technologies other than RFID, please contact ADT Program Staff at [email protected].

PERFORMANCE AND QUALITY CONTROLS
I certify that the identification device submitted for approval meets all performance and conformance
requirements as defined in the ADT General Standards.

Yes

No

Description of the quality control measures detailing the ability to produce and distribute the device
consistently and according to the specifications contained in the ADT General Standards, including
the full quality control plan and flow diagram for this identification device from manufacturing of all
components, encoding and/or imprinting, shipment and addressing consumer complaints, is attached.
If more than one company is involved with the manufacturing of the device components, a full quality
control plan is attached for the entity that performs each step and their location.

Yes

No

If requesting approval for a sheep and goat identification device, a signed Company Agreement for
Approval to Produce Official Eartags for Sheep and Goats is attached.

Yes

No

SIGNATURE
Applicant Signature

Date