VS 8-18 Statement of Services Performed

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 0579-0494. The time required to complete this information collection
is estimated to average 15 to 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. 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

OMB Approved
0579-0494
Exp. XX/XXXX

1. ACCOUNTING CLASSIFICATION

STATEMENT OF SERVICES PERFORMED
2. NAME AND ADDRESS OF PAYEE (Include Street Address and Zip Code)

3. PERIOD ENDING

4. CONTRACT OR AGREEMENT NUMBER

4. LOCATION OF VETERINARY SERVICES OFFICE

6. DATE OF
SERVICE

7. NAME AND ADDRESS OF HERD OWNER

8. TYPE OF SERVICE

9. NUMBER OF
UNITS

10. RATE PER
UNIT
$

11. AMOUNT
$

12. CERTIFICATION
I certify that the number of unit identified is correct, that the eservice rendered was in accordance with my contract or agreement and that payment has not been received from any other source.

13. SGNATURE OF PAYEE

DATE SIGNED

14. SIGNATURE OF APPROVING OFFICIAL

DATE SIGNED

VS Form 8-18
AUG 2023

Previous editions are obsolete