Permit to Conditionally Import a Dog Inadequately Immuni

Foreign Quarantine Regulations (42CFR71)

Attachment H Permit to Conditionally Import a Dog Inadequately Immunized...

Application for Permission to Import A Dog Inadequately Immunized Against Rabies

OMB: 0920-0134

Document [pdf]
Download: pdf | pdf
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
Centers for Disease Control and Prevention
Division of Global Migration and Quarantine, MS E-03
Atlanta, Georgia 30329
TEL: 404-498-1600 E-mail: [email protected]

Permit to Conditionally Import a Dog Inadequately Immunized against Rabies - Single Entry
In accordance with 42 CFR Section 71.51 of the Public Health Service Foreign Quarantine Regulations, permission is granted to the applicant to import
the dog (listed in item 3 below) into the specified port of entry under control of the United States.

PHS Permit No.
Date Issued:

Date Expires:

1. Applicant Name, Address,
Contact Information
2. Authorized Permit Holder, Address,
Contact Information (if different
from above)
3. Identification of Dog

4. Arrival Information

Date of Birth:

Age:

Breed:

Color:

Sex:

Microchip/Tattoo #:

Country of Origin:

U.S. Port of Entry:
Mode of Entry:

5. Approved Confinement Location

Dog may not be moved from the approved confinement location (except to go to a veterinary facility for
medical treatment or vaccination) until the conditions of issuance in item 6 below are satisfied.

6. Conditions of Issuance

The dog identified in item 3 above is conditionally admitted to the United States, subject to the
restrictions of section of 42 CFR 71.51 listed below:
1. _____ Confinement for _____ days to complete the 30-day period from the date of initial
antirabies vaccination.
2. _____ Confinement until 3 months of age, then initial antirabies vaccination, followed by
confinement for 30 days.
3. _____ Confinement until initial antirabies vaccination at destination (within 10 days of entry
into the United States), followed by confinement for 30 days.
4. _____ Confinement until booster antirabies vaccination at destination (within 10 days of entry
into the United States), provided that initial rabies vaccination was given at ≥ 3 months
of age.
5. _____ Other restrictions are as follows: _________________________________________________
The above restrictions are imposed under section 71.51 Title 42, Code of Federal Regulations,
and compliance is necessary before the dog is released from confinement.
“Confinement” as used above, means restriction of an animal, by the owner or his/her agent,
to a building or other enclosure isolated from people and other animals (except for contact
necessary for its care); if the dog is allowed out of said enclosure, muzzle the dog and keep
it on a leash.
NOTICE TO PERMITEE: Criminal penalties may be imposed for violating regulations enacted under 42 U.S.C. § 264. Under 42
U.S.C. § 271, as enhanced by 18 U.S.C. §§3559 & 3571, individuals violating a quarantine regulation may be sentenced to one
year in jail and/or a maximum fine of $100,000, if the violation does not result in a death or $250,000, if the violation results in a
death. Violations by an organization are punishable by a maximum fine of up to $200,000 per violation, if the violation does not
result in a death, or $500,000 per violation, if the violation results in a death.

7. Signature of Issuing
Public Health Officer
U.S. Customs and Border Protection should contact the CDC Quarantine Station with jurisdiction with any questions:
http://www.cdc.gov/quarantine/quarantinestationcontactlistfull.html


File Typeapplication/pdf
File Modified2015-05-12
File Created2015-05-12

© 2022 OMB.report | Privacy Policy