D: Forms

D: Forms

Appendix D – Forms and Instructions for Completing Them

VS Form 1–27, Permit for Movement of Animals, 16-3

VS Form 1–27A, Permit for Movement of Animals, Continuation Sheet, 16-4

VS Form 4–24, Brucellosis [Calfhood] Vaccination Record, Short Form, 16-7

VS Form 4–26, Brucellosis [Calfhood] Vaccination Record, Short Form, 16-9

VS Form 4–33, Brucellosis Test Record, 16-12

VS Form 4–33A, Brucellosis Test Record, Continuation Sheet, 16-13

VS Form 4–54, Brucellosis Test Record, Market Cattle Testing Program, 16-15

VS Form 6–22, Tuberculosis Test Record, 16-17

VS Form 6-22A, Tuberculosis Infected Herd, 16-18

VS Form 6-22B, Tuberculosis Test Record, Continuation Sheet, 16-19

VS Form 10–4, Specimen Submission, 16-24

VS Form 10-4A, Specimen Submission, Continuation Sheet, 16-26

VS Form 10–11, Equine Infectious Anemia Laboratory Test, 16-27

VS Form 10–12, Equine Infectious Anemia Supplemental Investigation, 16-29

VS Form 10–13, Owner Shipper Certificate, 16-33

VS Form 10–13A, Owner Shipper Certificate, Continuation Sheet, 16-35

VS Form 17–6, Certificate for Poultry or Hatching Eggs for Export, 16-37

VS Form 17–140, United States Origin Health Certificate, 16-39

VS Form 17–140A, United States Origin Health Certificate, Continuation Sheet, 16-41

APHIS Form 7001, United States Interstate and International Certificate of Health Examination for Small Animals, August 1994, 16-43

APHIS Form 7001, United States Interstate and International Certificate of Health Examination for Small Animals, November 2010, 16-44

APHIS Form 7001A, United States Interstate and International Certificate of Health Examination for Small Animals, Continuation Sheet, September 1993, 16-45

VS Form 17-145, United States Origin Health Certificate for the Export of Horses From the United States to Canada, 16-48

16-1

All pre-numbered APHIS and VS forms are accountable documents and failure to provide security for the forms is a violation of your accredited status. 

If you have any questions about completing or ordering these forms, you can contact your local APHIS-VS District Office or NIES Service Center at:  https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/contact-us 

The new VS Form 10-4 Specimen Submission form for NVSL is not pre-numbered and may be completed on line, printed out, and included with your specimens sent to NVSL.  The electronic form is available at: https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/lab-info-services/sa_diagnostic_tests/ct_diagnostic_tests

Veterinary Services is developing an electronic system called Veterinary Services Process Streamlining (VSPS) where many of these forms, as well as some of the international official health certificates of foreign destination countries, will be available on line. The VS form 10-11, Equine Infectious Anemia Laboratory Test, is already available in the VSPS. The form can be completed on line in VSPS and transmitted electronically to the laboratories that have linked up with VSPS. The electronic EIA test record has the capability to upload digital photos of the horse. See https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/nvap/ct_vsps_interstate_library



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