Form APHIS 7087 APHIS 7087 Animal Welfare Complaint Worksheet

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 0579-0036. The time
required to complete this information collection is estimated to average 30 minutes 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
ANIMAL CARE

ANIMAL WELFARE COMPLAINT
COMPLAINT NO.:

DATE ENTERED:

PROCESSED BY:

REFERRED TO:

REPLY DUE:

FACILITY OR PERSON COMPLAINT FILED AGAINST
NAME:

CUSTOMER NO.:

ADDRESS:

LICENSE NO.:

EMAIL ADDRESS:

CITY:

STATE:

TELEPHONE NO.:

COMPLAINANT INFORMATION
NAME:

ORGANIZATION:

ADDRESS:

EMAIL ADDRESS:

CITY:

STATE:

TELEPHONE NO.

HOW WAS COMPLAINT RECEIVED?

DETAILS OF COMPLAINT:

RESULTS:

APPLICATION KIT PROVIDED:
YES

NO

INSPECTOR:

DATE:

REVIEWED BY:

DATE:

APHIS FORM 7087
FEB 2023

OMB APPROVED
0579-0036