VS 6-22 Cooperative State - Federal Tuberculosis Eradication Pro

Tuberculosis

VS 6-22 FEB 2020 (20230307) SEC

Business

OMB: 0579-0146

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OMB Approved
0579-0146
EXP: XX/XXXX

COOPERATIVE STATE - FEDERAL TUBERCULOSIS
ERADICATION PROGRAM

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

TUBERCULOSIS TEST RECORD

ALL INCOMPLETE RECORDS WILL BE RETURNED FOR COMPLETION
STATE

COUNTY

TWP

SEC

HERD OWNER - LAST NAME, FIRST MI

Serial No.

HERD OWNER COMPLETE ADDRESS

PREVIOUS VET CODE
TEST DATE

TOTAL

REA

CERTIFICATION FOR PAYMENT

HERD NUMBER

SUS

DATE LISTED

STATE/FEDERAL EXPENSE
OWNER EXPENSE

COUNTY

D-B

U

TOWNSHIP OR DISTRICT

1

6
RETEST

HERD
(RE)ACCREDIT

2

3

MILK
ORDINANCE

4
SALE SHOW
5

AFFECTED
HERD

TRACING
REG. KILL
TRACING
REACTORS
TRACING
EXPOSED
OTHER

7

FARM NUMBER

COMPLETE HERD TEST OF ALL
ELIGIBLE ANIMALS

REASON FOR TEST
AREA

SECTION

YES
NUMBER OF ELIGIBLE
ANIMALS IN HERD:
KIND OF HERD

8

NO

DEER

BISON

ELK

CATTLE

CAUDAL FOLD
(CFT)

SNG CERVICAL
(SCT) (CERVID)

CERVICAL
(CT) (BOVINE)

OTHER

AGE

BREED

SEX

NRS

1

SIZE

RESULTS
OFFICIAL
IDENTIFICATION NUMBER

TELEPHONE

NEGATIVE

PRACTITIONER NAME (print)

AGREE CODE

SUSPECT

INJECTION

DATE

HOUR

OBSERVATION

DATE

HOUR

REACTOR

METHOD OF TEST

10

PRACTITIONER SIGNATURE

SUMMARY

OTHER
9

I certify that this test was made and read by me on each of the cattle
identified below on the dates and with the results as entered in
appropriate spaces, and that when payment is claimed at program
expense in accordance with agreement number below, no payment
has been or will be received from any other source.

TOTAL

RESULTS

1

OFFICIAL
IDENTIFICATION NUMBER

1.

16.

2.

17.

3.

18.

4.

19.

5.

20.

6.

21.

7.

22.

8.

23.

9.

24.

10.

25.

11.

26.

12.

27.

13.

28.

14.

29.

15.

TUBERCULIN SERIAL NUMBER

AGE

BREED

30.
I hereby acknowledge receiving a copy of this record which I have
examined and find correct.

RT – Retag
NA – Natural Addition
PA – Purchased Addition

VS Form 6-22
FEB 2020

SEX

NRS

TEST

SIZE

LESION

N – Negative
S – Suspect
R – Reactor

OWNER SIGNATURE

(Previous editions are obsolete.)

DATE

THIS AUTHORIZATION
TO TEST EXPIRES:


File Typeapplication/pdf
AuthorHarris, Sheniqua M - APHIS
File Modified2023-03-07
File Created2019-07-19

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