Veterinarian Short

Shortage ID: ________________ VMLRP USE ONLY

NIFA Veterinary Medicine
Loan Repayment Program (VMLRP)

National Institute of Food and Agriculture
US Department of Agriculture
Form NIFA 2009-0001
OMB No. 0524-0050
Form Approved For Use Through XX/XX/XXXX

VETERAN SHORTAGE SITUATION NOMINATION FORM
Veterinary Medicine Loan Repayment Program (VMLRP)
This form must be used for Nomination of Veterinarian Shortage Situations to the Veterinary Medicine Loan Repayment Program
(VMLRP), Authorized Under the National Veterinary Medical Service Act (NVMSA). This form must be submitted under the authority
of the Chief State or Insular Area Animal Health Official.
For Nominating Official: Submit one separate nomination form for each shortage situation. Visit the VMLRP Shortage Allocations
section of the VMLRP web site (http://www.nifa.usda.gov/resource/vmlrp-shortage-allocations) for the number of nominations
permitted for each state or insular area.

1. Location of Veterinary Shortage Area for this Nomination
a.

Must Service Location(s):
(e.g., County, State/Insular Area; must be a logistically feasible veterinary practice service area)

b.

May Service Location(s):

c.

Approximate Center of Shortage
Area (or Location of Position if
Type III):

(e.g., County, State/Insular Area; must be a logistically feasible veterinary practice service area)

(e.g., Address or Cross Street, Town/City, and Zip Code)

2. Overall Priority of Shortage: ____________________
3._______________________________________________________________________________
Type of Veterinary Practice Area/Discipline/Specialty (select one):
a.

For Type I or II Private Practice, select species and/or production types to cover:
Must cover (must check at least one)
 Beef Cattle
 Dairy Cattle
 Swine
 Poultry
 Small Ruminant
 Other:

May cover
 Beef Cattle
 Dairy Cattle
 Swine
 Poultry
 Small Ruminant
 Other:

1
NIFA invests in and advances agricultural research, education, and extension and promotes transformative discoveries that solve societal challenges.
USDA is an equal opportunity lender, provider and employer.

b. For Type III Public Practice:
Employer:
Position Title:
Please select one or more specialty/disciplinary areas:
 Food Safety
 Public Health
 Epidemiology
 Other:
b. (Optional) If the nominator wishes to specify a service time for this shortage situation that is higher
than the minimum required for the shortage type checked above, please specify the percent time in
the box below (based on a 40-hour work week). Leave the box blank if the service time for this
shortage situation is for the minimum percent time of the shortage type indicated.

%

4. Referring to the characteristics identified in response to question 3 above and the location to be served, describe in
detail the need for a veterinarian in this shortage situation area. Include state, national, or local data to support the
description of the need, such as numbers of animals, farms/ranches, markets, etc. (Limit your response to 2000
characters).

5. Referring to the characteristics identified in response to question 3 above, describe the services that a veterinarian
must be willing to provide to meet this shortage situation’s needs in the community, area, state/insular area, or
position requested above (limit your response to 2000 characters).

2
NIFA invests in and advances agricultural research, education, and extension and promotes transformative discoveries that solve societal challenges.
USDA is an equal opportunity lender, provider and employer.

6. To help you promote your shortage nomination, what aspects of the community (outdoor activities, community

strengths, etc.) would attract a veterinarian to the service area or state? What would be the major attractions for
the veterinarian to join the community? (limit your response to 2000 characters.)

7. Describe any past efforts to recruit and retain a veterinarian in the shortage situation identified above (limit your
response to 1000 characters).

8. Describe the consequences of this veterinary position not being secured or retained. Include the risk(s) to the

production of a safe and wholesome food supply and to animal, human, and environmental health not only in the
community but in the region, state/insular area, nation, and/or international community. Describe why this shortage
is a critical, high, or moderate priority. (limit your response to 2500 characters.)

3
NIFA invests in and advances agricultural research, education, and extension and promotes transformative discoveries that solve societal challenges.
USDA is an equal opportunity lender, provider and employer.

9. SAHO nominator must check both boxes below in order for NIFA to consider this nomination for official designation



a. By checking this box, I affirm that this form represents a nomination and is subject to NIFA review
and approval.



b. By checking this box, I affirm that it is my professional opinion that this is a bona fide food supply or
public health-related veterinary shortage situation. I affirm due diligence has been invested to identify
this area as a shortage situation of at least moderate priority (severity).

c. Authorized State or Insular Area Animal Health Official or designee:
Name:
Title:

Organization:

Email:

Telephone Number:
(Area code required)

Public reporting for collection of information is estimated to average two hours, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency
may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless it displays a current valid OMB
control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to NIFA, OGFM, 2312 East Bannister Road, Mail Stop 10,000, Kansas City, MO 64131, Attention
Policy Section. Do not return the completed form to this address.

Form NIFA 2009-0001
OMB No. 0524-0050

4
NIFA invests in and advances agricultural research, education, and extension and promotes transformative discoveries that solve societal challenges.
USDA is an equal opportunity lender, provider and employer.