VS 4-108B Animals Removed from Infected Herd

See Notice/Instructions on Reverse
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB Approved 0579-0047
Exp XX/XXXX

See reverse for additional OMB statement
1. NAME OF HERD OWNER

ANIMALS REMOVED FROM INFECTED HERD
SUPPLEMENTAL TO VS FORM 4-108

INSTRUCTIONS: List all animals (include feeder
heifers and slaughtered cows and bulls but
exclude reactors) sold or otherwise removed from
the herd within the last two years, or since infection
was introduced. Obtain all supporting documents.

3. COUNTY

2. DOCUMENT NUMBER
4. HERD NO.

5.
PAGE

OF

PAGES

6. LIST OF ANIMALS SOLD OR OTHERWISE REMOVED FROM THE HERD

7. ASSIGNMENTS MADE TO CONTACT RECIPIENT HERDS

Yes

C

D

8. SIGNATURE OF VMO

No

VS FORM 4-108B
APR 2009

Previous edition may be used

E

F

G

H

I

J

CODE

Verified
(see codes)

Disposition

B

Vac. Status

A

Tag No’s

Breed

Date

OTHER ID
(Brands, Tattoos, etc.)

Age when
Sold

NAME AND ADDRESS

IDENTIFICATION

Sex

SALES
No. of
Animals

BUYER OR RECIPIENT

K

REMARKS
(Stage of pregnancy, etc.)

L

9. DATE SIGNED

BRUCELLOSIS
STATUS
1 – Untested
2 – Tested Neg.
M

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 0579-0047. The time
required to complete this information collection is estimated to average 4 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.
_________________________________________________________________________________________________________________________

NOTICE TO HERD OWNERS
Herd Owners (Managers or Agents) of herds of brucellosis affected livestock must be advised
that information is given voluntarily to assist in the elimination of brucellosis from the livestock
population. Cooperation of all affected herd owners (Managers or Agents) is needed to
complete a thorough epidemiologic investigation to identify the source of the disease, the
method of spread and the possible dissemination to new herds. The authorities under which the
brucellosis program is conducted are contained in 21 U.S.C. 111, 112, 114, 114a, 114a-1, 115,
120, 121, 125, and 134a-f and Title 9, Code of Federal Regulations, Parts 51 and 78.

INSTRUCTIONS
The purpose of this form is to record information of epidemiologic importance for each potentially
brucella exposed animal removed from this herd. This information facilitates tracing of each
animal for retesting or for verification of slaughter.

1-4.

From 4-108. Item 2 is the preprinted number on the 4-108.

5.

Indicate which page of 4-108B this is and how many total
pages were completed.

6.

List each animal (except steers or reactors) removed from
the herd for any reason since it became infected (if this date
can be established) or otherwise for the 2-year period prior
to discovery of infection.

6-A.

Record the full legal name and mailing address of the
recipient of each animal. Each animal should be listed
individually if individual identification is available; otherwise
they may be listed by transaction lots.

6-B.

Record the date this herd owner gave up control of the
animals.

6-C.

Indicate the number of animals involved with each
transaction.

6-D.
and E.

Record all available identification at time of sale (removal
from premises) for each animal including eartags, salestags,
backtags, bangle tags, brands, identification tattoos, and
registration numbers.

6-F.

Enter F (female) or M (male). If a lot, indicate the number
of each.

6-G.

Age at time of removal from herd. If a lot, indicate the
average or predominant age.

6-H.

Indicate the specific breed. If nondescript, indicate the breed
that the animal most appears to represent. For lots, enter
the predominant breed or record as mixed beef, etc.

6-I.

Record the vaccination status as “CV,” “AV,” “NV” (not
vaccinated), or “UN” (unknown) and list the vaccination
tattoo, if applicable.

6-J.

Indicate disposition of animals by recording “S” for slaughter,
“F” for feedlots, veal feeding, dairy heifer lot, etc., and “H” for
herd replacement.

6-K.

Indicate the status of the tracing on each animal by 1
(slaughter verified), 2 (located and retested), 3 (located but
not tested), 4 (recipient state notified), or 5 (not verified).

6-L.

Record the stage of pregnancy and other pertinent
information as of the time of sale. Also list the buyer if
different than that given in A.

6-M.

List status of animal when it left the herd or first point of
concentration.

7.

Indicate if arrangements have been made to contact
everyone that received animals from this herd.

8-9.

Self-explanatory.

Submit copies of any documents that may help trace the animals such as invoices, brand inspection, cancelled checks, etc.

VS FORM 4-108B (Reverse)

Privacy Act Notice
Veterinary Services – Brucellosis Information System and Brucellosis Recording and Reporting System
Authority: 21 U.S.C. 111, 112, 114, 114a-1, 115, 120, 121, 125, 134a-134f and title 9, Code of Federal Regulations, part 51 and
part 78.
Purpose and Routine Uses:
Routine uses of records maintained in the system, including categories of users and the purposes of such uses:
1)
2)
3)
4)
5)
6)
7)

Detecting the foci of infection to reduce the rate of spread of infection to new herds;
Evaluating brucellosis program activities of State, Federal, and contractual personnel;
Preparing mailing labels and preaddressed forms to enhance field activities;
Evaluating program effectiveness;
Detecting factors of epidemiologic importance in containing or eliminating foci of infected herds;
Assuring that brucellosis indemnities are promptly and properly paid;
Notification of livestock owners with the animals at high risk of exposure to brucellosis because of livestock movements or
an outbreak of disease or presence of quarantined premises in a community;
8) Referral to the appropriate agency, whether Federal, State, local, or foreign, charged with responsibility of investigating or
prosecuting a violation of law concerning animal disease control and eradication, or of enforcing or implementing a
statute, rule, regulation, or order issued pursuant thereto, of any record within this system when information available
indicates a violation or potential violation of law concerning animal disease control and eradication, whether civil, criminal,
or regulatory in nature, and either arising by general statute or particular program statute, or by rule, regulation, or court
order issued pursuant thereto;
9) Litigation by the Department of Justice when the agency, or any component thereof, or any employee of the agency in his
or her official capacity, or any employee of the agency in his or her individual capacity where the Department of Justice
has agreed to represent the employee, or the United States, where the agency determines that litigation is likely to affect
the agency or any of its components, is a party to litigation or has an interest in such litigation, and the use of such
records by the Department of Justice is deemed by the agency to be relevant and necessary to the litigation; provided,
however, that in each case, the agency determines that disclosure of the records to the Department of Justice is a use of
the information contained in the records that is compatible with the purpose for which the records were collected;
10) Use in a proceeding before a court or adjudicative body before which the agency is authorized to appear, when the
agency, or any component thereof, or any employee of the agency in his or her official capacity, or any employee of the
agency in his or her individual capacity where the agency has agreed to represent the employee, or the United States,
where the agency determines that litigation is likely to affect the agency or any of its components, is a party to litigation
or has an interest in such litigation, and the agency determines that use of such records is relevant and necessary to the
litigation; provided, however, that in each case, the agency determines that disclosure of the records to the court is a use
of the information contained in the records that is compatible with the purpose for which the records were collected; and
11) Response to a request from a congressional office from the record of an individual made at the request of that individual.
To certain Federal and State animal health officials to conduct, analyze, and report on the progress of animal disease
control or surveillance programs.

Disclosure: Furnishing this information is voluntary; however, failure to furnish this information may impede brucellosis
eradication activities.

Form Copy Designations
PART 1-HERD FILE
PART 2-CATTLE DISEASES STAFF,
RIVERDALE, MD (Free Areas only)
PART 3-STATION EPIDEMIOLOGIST
PART 4- STATE OR FEDERAL FIELD
VETERINARIAN