VS 5-20 Individual Animal Information Report

OMB APPROVED
579-0101
EXP XX/XXXX

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 0579-0101. The time required to complete this information collection is estimated to average .5 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.

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

1. INSPECTION DATE

INDIVIDUAL ANIMAL INFORMATION REPORT
(For Flock Additions, Clinically Suspicious, Infected, and Traced Animals)
2. FLOCK NAME/CONTACT

3. FLOCK ID

4. INSPECTOR ID

(Obtain Flock letter from VS Form 5-19, block 23, if applicable.)

SECTION I - ANIMAL NO.

FLOCK LETTER

5. FLOCK TAG

6. REGISTRATION NUMBER

7. EARTAG

8. OFFICIAL ID NO. AND TYPE

9. SEX

10. BREED

11. DATE OF BIRTH

E
I
12. ENTRY DATE

14. FLOCK OF ORIGIN ID

15. DISPOSITION

M

F

O

T

W

13. FLOCK OF ORIGIN

Sold
16. SIRE EARTAG

17. SIRE OFFICIAL ID AND TYPE

20. DAM EARTAG

21. DAM OFFICIAL ID AND TYPE

24. DISPOSITION DATE

28. TEST TYPE

Loaned

Died

Slaughtered

Unknown

18. SIRE FLOCK TAG

19. SIRE REGISTRATION NUMBER

22. DAM FLOCK TAG

23. DAM REGISTRATION NUMBER

25. DISPOSITION FLOCK

26. DISPOSITION FLOCK ID

27. LAB RESULTS

29. SAMPLE DATE

30. DISEASE STATUS

31. DATE OF STATUS

E

I

E

O

T

I

O

T

32. CLINICAL SIGNS

33. REMARKS

E - Eartag
I - Implant
T - Tattoo
O - Other
(Obtain Flock letter from VS Form 5-19, block 23, if applicable.)

SECTION II - ANIMAL NO.

FLOCK LETTER

34. FLOCK TAG

35. REGISTRATION NUMBER

36. EARTAG

37. OFFICIAL ID NO. AND TYPE

38. SEX

39. BREED

40. DATE OF BIRTH

41. ENTRY DATE

43. FLOCK OF ORIGIN ID

44. DISPOSITION

E

M

F

42. FLOCK OF ORIGIN

I

O

T

W

Sold
45. SIRE EARTAG

46. SIRE OFFICIAL ID AND TYPE

49. DAM EARTAG

50. DAM OFFICIAL ID AND TYPE

53. DISPOSITION DATE

57. TEST TYPE

Loaned

Died

Slaughtered

Unknown

47. SIRE FLOCK TAG

48. SIRE REGISTRATION NUMBER

51. DAM FLOCK TAG

52. DAM REGISTRATION NUMBER

54. DISPOSITION FLOCK

55. DISPOSITION FLOCK ID

56. LAB RESULTS

58. SAMPLE DATE

59. DISEASE STATUS

60. DATE OF STATUS

E

E

I

I

T

T

O

O

61. CLINICAL SIGNS
62. REMARKS

VS FORM 5-20
DEC 2011

E - Eartag
I - Implant
T - Tattoo
O - Other
(Previous editions are obsolete.)

44. SIRE FLOCK TAG

45. SIRE REGISTRATION NUMBER

48. DAM FLOCK TAG

49. DAM REGISTRATION NUMBER

44. SIRE FLOCK TAG

45. SIRE REGISTRATION NUMBER

48. DAM FLOCK TAG

49. DAM REGISTRATION NUMBER