NAHMS 471 On-Farm Monitoring of Antimicrobial Use and Resistance i

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 0579-0481. The time required
to complete this information collection is estimated to average 1.50 hours per response, including the
time to review instructions, search existing data resources, gather the data needed, and complete and
review the information collected. Send comments regarding this burden statement or any other aspect
of this information collection, including suggestions for reducing this burden, to [email protected].
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
NATIONAL ANIMAL HEALTH MONITORING SYSTEM
2150 CENTRE AVE, BLDG B
FORT COLLINS, CO 80526

OMB Approved
0579-0481
EXP: XX/XXXX

ON-FARM MONITORING OF
ANTIMICROBIAL USE AND
RESISTANCE IN U.S. BROILER
PRODUCTION SURVEY

Farm ___

Quarter __

All data entered below are for the HOUSE that is being sampled.

Date Placed

Date Sampled

Planned Age of
Slaughter

Downtime from
prior flock

7-day Mortality

Number Placed

Was litter reused? (circle one)

YES NO If Yes, how many times? __________

Was in-ovo gentamicin used? (circle one)

YES NO If Yes, dose per bird __________

Were antibiotics / ionophores used in the feed? (circle one)
Ionophores
Drug

Dose (g/ton)

Starting Age

YES NO

Duration (days)

Farm ___

Quarter __

Antibiotics in feed (feed efficiency / disease prevention)
Drug

Indication

Dose (g/ton)

Starting Age

Duration

Antibiotics for disease treatment and control (water or feed)
Drug

Indication

Route (W / F)

Total Amount

Starting Age

Duration