Aphis 2007 Qualifications Of Veterinary Biologics Personnel

INSTRUCTIONS FOR COMPLETING APHIS FORM 2007
This Form shall be completed for each supervisory employee responsible for essential steps in production, testing, and initial distribution
of biological products. Send one copy to CVB.
Item 1

Self-explanatory

2

"High school" need not be listed if education includes at least one year in an accredited college or university requiring
a high school diploma for admission.

3A

List present position first and work back.

3B

Self-explanatory

3C & D

Show length of time in each position, including present position.

3E

Use official title from company records. If that title is not descriptive, add a descriptive title and identify with the
initials "DT" (descriptive title).

4&5

Self-explanatory

This report is required by regulations (9 CFR 102.4 and 114.7). Failure to
report can result in suspension or revocation of establishment license.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information is 0579-0013. The
time required to complete this information collection is estimated to average .16 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.

OMB NO. 0579-0013

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

1. NAME OF EMPLOYEE (Last, first, middle)

QUALIFICATIONS OF VETERINARY BIOLOGICS PERSONNEL
(See instructions on attached page.)
2. EDUCATION
NAME OF HIGH SCHOOL, COLLEGE,
OR UNIVERSITY

NO. OF
YEARS
COMPLETED

(A)

DATES ATTENDED
From

To

MAJOR SUBJECTS

DEGREE

(B)

(C)

(D)

(E)

(F)

ESTAB. LIC.
NUMBER
(if known)

From

To

(B)

(C)

(D)

DATE CONFERRED
(G)

3. BIOLOGICS WORK EXPERIENCE
NAME AND ADDRESS OF
ESTABLISHMENT
(A)

PERIOD
TITLE OF
POSITION HELD
(E)

RELATED WORK PERFORMED
(if more space is needed, attach sheet)
(F)

Present

4. SIGNATURE OF EMPLOYEE

5. DATE PREPARED

(See Privacy Act Notice
at the bottom of Form)
APHIS FORM 2007
(NOV 2001)

Previous editions are obsolete.

PRIVACY ACT NOTICE
The information requested on this form will not be retrieved from our files by using your name or personal identifier and is therefore, in the opinion of this Agency, not subject
to provisions of the Privacy Act of 1974. However, in keeping with the spirit and intent of the Privacy Act we are informing you of the following:
Authority:

9 CFR Section 114.7(a)

Purpose:

That compliance with the Act and applicable regulations be under supervision of person(s) competent in the preparation of biological products.

Routine uses:

To determine that the responsible person(s) producing biological produc ts are qualified by training and experience and have demonstrated fitness to
produce such products in compliance with the Act.

Effects of failure to furnish information:
Failure to report can result in suspension or revocation of establishment license. Failure to provide the requested personal information will result in no
personal penalties or adverse consequences.