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According to the paperwork reduction Act of 1995, no persons are required to
ICR 202607-0579-003 · OMB 0579-0036 · Object 170739200.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | According to the paperwork reduction Act of 1995, no persons are required to |
| Author | Government User |
| Last Modified By | Acrobat PDFMaker 21 for Word |
| File Modified | 2021-05-27 |
| File Created | 2021-05-26 |
| Conversion State | complete |
Extracted Text
Clear Form 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. OMB APPROVED 0579-0036 A record of dog and cat acquisition is required by law (7 U.S.C. Section 2140). Dealers and exhibitors shall use this form (9 C.F.R. Section 2.75). Research facilities may use this form (9 C.F.R. Section 2.35). Failure of a dealer or exhibitor to maintain this record can result in an assessment of a civil penalty of not more than $10,000 (7 U.S.C. Section 2149). UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE 1. SELLER’S INVOICE NUMBER OF RECORD OF DISPOSITION OF DOGS AND CATS SALE EXCHANGE OR TRANSFER 2. PAGE 3. DATE OF DISPOSITION DONATION 4A. SELLER OR DONOR (name and address) 5A. BUYER OR RECEIVER (name and address) 4B. DEALER’S LICENSE NUMBER OR RESEARCH FACILITY REGISTRATION NUMBER 5B. USDA LICENSE NUMBER OR RESEARCH FACILITY REGISTRATION NUMBER (if any) 6. DELIVERY BY (check one and complete applicable items 8 and 9) COMMERCIAL SHIPPER BUYER’S VEHICLE SELLER’S VEHICLE 7. NAME AND ADDRESS OF COMPANY OR FIRM (include ZIP code) 8. NAME AND ADDRESS OF TRUCK DRIVER (include ZIP code) 9. RECEIVED BY 11. TITLE 10. SIGNATURE 12. DATE 13. IDENTIFICATION OF ANIMALS BEING DELIVERED (* See reverse for breed abbreviations for dogs and cats. If mixed breed, list 2 dominant breeds) COMPLETE ITEMS A THRU G FOR EACH ANIMAL A. B. C. DOG IDENTIFICATION NUMBER CAT “X” M OR F M AGE OR DATE OF BIRTH E. F. WEIGHT BREED OR TYPE * G. M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F APHIS FORM 7006 MAY 2021 D. F Previous versions of this form will be accepted. DESCRIPTION OF ANIMAL (color, distinctive marks, hair, tail, tattoos, etc.) BREED ABBREVIATIONS – DOGS (Column F) Afghan Hound Airedale Terrier Akita American Bull Terrier Basenji Basset Hound Beagle Bedlington Terrier Bichon Frise Black and Tan Coonhound Bluetick Boston Terrier Boxer Bullmastiff Cairn Terrier Catahoula Chihuahua Chinese Crested Dog Chow-Chow Cocker Spaniel Collie Coonhound (Specify) Dachshund Dalmatian Doberman Elkhound English Bulldog - AH - AD - AK - AB - BS - BH - BE - BL - BF - BT - BK - BO - BX - BM - CT - CU - CA - CD - CC - CK - CL - CH - DH - DL - DB - EH - EB English Setter Eskimo Dog Foxhound Fox Terrier French Bulldog German Shepherd German Short Haired Pointer Golden Retriever Gordon Setter Great Dane Great Pyrenees Greyhound Husky Irish Setter Jack Russell Terrier Keeshond King Charles Spaniel Komondor Labrador Retriever Lhasa Apso Malamute Mastiff Maltese Miniature Pinscher Newfoundland Old English Sheepdog Pekingese - ES - ED - FH - FT - FB - GS - SH - GR - GO - GD - GP - GH - HK - IS - JR - KH - KC - KM - LR - LA - MM - MA - MT - MP - NF - OE - PK Pomeranian Poodle Pug Redbone Coonhound Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Schipperkee Schnauzer Scottish Terrier Shar-pei Shetland Sheepdog Shih-tzu Silky Terrier Spitz Springer Spaniel Staffordshire Bull Terrier Walker Weimaraner Welsh Corgi Whippet Yorkshire Terrier Other (specify) DOGS, CROSSBREED Hound Crossbreed Terrier Crossbreed Shepherd Crossbreed Spaniel Crossbreed - HX - TX - SX - PX BREED ABBREVIATIONS – CATS (Column F) Abyssinian Burmese Domestic Long Hair Domestic Short Hair Himalayan Maine Coon APHIS FORM 7006 (REVERSE) - AB - BU - DL - DS - HM - MC Manx Persian Russian Blue Rex Siamese - MX - PR - RB - RE - SI Other (specify) - PM - PO - PU - RB - RR - RW - SB - SM - SK - SN - SC - SP - SS - SI - ST - SZ - SR - SA - WK - WI - WC - WH - YT Privacy Act Notice Authority: The Animal Welfare Act (AWA), 7 U.S.C. 2131 et seq., and the regulations issued thereunder, 9 CFR parts 1 through 4; and the Horse Protection Act (HPA), 15 U.S.C. 1821 et seq., and the regulations issued thereunder, 9 CFR parts 11 and 12. Purpose: This system supports APHIS’ administrative activities and enforcement of the AWA and HPA. Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C. 552a (b) of the Privacy Act, records maintained in the system may be disclosed outside USDA as follows: (1) APHIS may disclose the name, city, State, license or registration type and/or status, or change of a license or registrant to any person pursuant to 9 CFR 2.38(c) and 2.127; (2) APHIS may disclose annual reports submitted to APHIS by licensees and research facilities to any person pursuant to 9 CFR 2.7 and 2.36; (3) APHIS may disclose inspection reports and other regulatory correspondence issued to licensees and registrants [from the agency] to any attending veterinarian in order to carry out duties under the AWA pursuant to 9 CFR 2.33 and 2.40; (4) APHIS may disclose the name, telephone number and other contact information, location, inspection reports, and regulatory and other correspondenceof licensees, registrants, permitees, and applicants for the same, to appropriate Federal, foreign, State, local, Tribal, or other public authority agencies or officials, in order to carry out duties under the AWA or State, local, Tribal or other public authority on the same subject pursuant to 7 U.S.C. 2145(b); (5) APHIS may disclose inspection reports of licensees and registrants, and permit status, to any pet store or other entity that is required under State, local,Tribal, or other public authority to verify a licensee, registrant, or permitee’s compliance with the AWA; (6) APHIS may disclose information to the National Academies of Sciences, Engineering, and Medicine, and any other research institution engaged or approved by the Department, to the extent APHIS deems the disclosure necessary to complete research and/or compile a report in furtherance of the Department’s mission; (7) APHIS may disclose final adjudicatory AWA and HPA decisions or orders by an appropriate authority to any person; (8) APHIS may disclose to any person the name, city, and State or other information to the extent necessary for proper identification of persons (referred to as “Designated Qualified Persons” or “DQPs”) that are or have been qualified to detect and diagnose a horse that is sore or otherwise inspect horses for purposes of enforcing the HPA and of horse industry organizations or associations (referred to as “HIOs”) that have currently or have had in the past DQP programs certified by the USDA; (9) APHIS may disclose to any regulated horse owner, HIO, and other entities responsible for licensure or required to verify compliance with the HPA, HPA inspection findings and regulatory and other correspondence issued to persons or entities regulated under the HPA; (10) APHIS may disclose to any person the name, city, and State or other information to the extent necessary for proper identification of any person or entity who has been disqualified, suspended, and/or otherwise prohibited from showing or exhibiting any horse, or judging or managing any horse show, horse exhibition, horse sale, or horse auction under the HPA and the terms of such action; (11) APHIS may disclose to any person the name, city, and State or other information to the extent necessary for proper identification of any regulated individual or entity whose license or permit has been suspended, revoked, expired, terminated, or denied under the AWA and the terms of such action; (12) APHIS may disclose to appropriate law enforcement agencies, entities, and persons, whether Federal, foreign, State, local, or Tribal, or other public authority responsible for enforcing, investigating, or prosecuting an alleged violation or a violation of law or charged with enforcing, implementing, or complying with a statute, rule, regulation, or order issued pursuant thereto, when a record in this system on its face, or in conjunction with other records, indicates a violation or potential violation of law, whether civil, criminal, or regulatory in nature, and whether arising by general statute or particular program statute, or by regulation, rule, or court order issued pursuant thereto, if the information disclosed is relevant to any enforcement, regulatory, investigative, or prosecutive responsibility of the receiving entity; (13) APHIS may disclose to the Department of Justice when the agency, or any component thereof, or any employee of the agency in his or her official capacity, or any employee of the agency in his or her individual capacity where the Department of Justice has agreed to represent the employee, or the United States, in litigation, where the agency determines that litigation is likely to affect the agency or any of its components, is a party to litigation or has an interest in such litigation, and the use of such records by the Department of Justice is deemed by the agency to be relevant and necessary to the litigation; provided, however, that in each case, the agency determines that disclosure of the records to the Department of Justice is a use of the information contained in the records that is compatible with the purpose for which the records were collected; (14) APHIS may disclose information in this system of records to a court or adjudicative body in administrative, civil, or criminal proceedings when: (a) The agency or any component thereof; or (b) any employee of the agency in his or her official capacity; or (c) any employee of the agency in his or her individual capacity where the agency has agreed to represent the employee; or (d) the United States Government, is a party to litigation or has an interest in such litigation, and by careful review, the agency determines that the records are to be for a purpose that is compatible with the purpose for which the agency collected the records; (15) APHIS may disclose information from this system of records to appropriate agencies, entities, and persons when: (a) USDA suspects or has confirmed that there has been a breach of the system of records; (b) USDA has determined that as a result of the suspected or confirmed breach there is a risk of harm to individuals, USDA (including its information systems, programs, and operations), the Federal Government, or national security; and (c) the disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with USDA’s efforts to respond to the suspected or confirmed compromise and prevent, minimize, or remedy such harm; (16) APHIS may disclose information from this system of records to another Federal agency or Federal entity, when the USDA determines that information from this system of records is reasonably necessary to assist the recipient agency or entity in (a) responding to a suspected or confirmed breach or (b) preventing, minimizing, or remedying the risk of harm to individuals, the recipient agency or entity (including its information systems, programs, and operations), the Federal Government, or national security, resulting from a suspected or confirmed breach; (17) APHIS may disclose information in this system of records to USDA contractors and other parties engaged to assist in administering the program, analyzing data, developing information management systems, processing Freedom of Information Act requests, and conducting audits. Such contractors and other parties will be bound by the nondisclosure provisions of the Privacy Act; (18) APHIS may disclose information in this system of records to USDA contractors, partner agency employees or contractors, or private industry employed to identify patterns, trends, or anomalies indicative of fraud, waste, or abuse; (19) APHIS may disclose information in this system of records to a Congressional office from the record of an individual in response to any inquiry from that Congressional office made at the written request of the individual to whom the record pertains; (20) APHIS may disclose information in this system of records to the National Archives and Records Administration or to the General Services Administration for records management activities conducted under 44 U.S.C. 2904 and 2906; and (21) APHIS may disclose information in this system of records to the Treasury Department as necessary to carry out any and all functions within their jurisdiction, including but not limited to, processing payments, fees, collections, penalties, and offsets. Disclosure: Furnishing this information is voluntary; however, failure to furnish this information may impede your ability to comply with the requirements of the Animal Welfare Act, regulations, and standards.