VS 4-30 Cooperative State Federal Johne's Program Voluntary Bovi

According to the Paperwork Reduction Act of 1995, no persons are required to re spond to a collection of information unless it displays a valid OMB control num ber.
The valid OMB control number for this information collection is 0579 XXXX. The time required to complete this information collection is estimated to average .5 hours
per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and re viewing
the collection of information.

FORM APPROVED
OMB NUMBER
0579-XXXX

1. STATE

COOPERATIVE STATE FEDERAL JOHNE'S PROGRAM
VOLUNTARY BOVINE JOHNE'S DISEASE CONTROL PROGRAM TEST RECORD

2. COUNTY

3. PREMISES ID

4. HERD OWNER

LAST NAME

FIRST NAME

11. Certification

ROUTE-STREET-ROAD
CITY

STATE

5. REASON FOR TEST
Initial

Slaughter

6. RGE

TWP

SEC

GPS
LOCATION

Fed Basis (Federal)

State County

Private (Owner's Expense)

NO

I certify:
That I have collected samples from each animal identified below and have correc tly listed
each sample number with completed corresponding identification number, all numb ers and
letters of all eartags have been listed, cattle with existing official eartags have not been
retagged, and when payment is claimed as program expense in accordance with agreement
number below, no payment has been or will be received from any other source.

Signature:

7. Completed Herd Test of all Eligible Animals
YES

Federal Employee
ZIP CODE

Retest

Herd
Certification

INITIAL

Date:

NO. IN HERD
Route, Street, Road

Livestock
Market
reason

Epidemiology

Diagnostic

Area Test

Private
Sale

Other (specify
in remarks)

SUMMARY

8. Kind of Herd

Negative

City

9. Species

Suspect

Remarks

10. Laboratory

Positive

Date

Totals

Dairy

Beef

Mixed

State

14. Test Results

12. Test to Run:
13. SAMPLE
NO.

VS 4-30
(MAY 2007)

RECORD ALL IDENTIFICATION
NUMBER (S)

VACC.
TATTOO

AGE BREED

SEX

ELISA

CULTURE

PCR

Zip Code

INSTRUCTIONS FOR THE JOHNE’S PROGRAM TEST RECORD CONTINUATION SHEET

(VS FORM 4-30)

The purpose is to outline the Voluntary Bovine Johne’s Disease Control Program test record form. The major objectives of the test r ecord are to provide uniformity in
recording and reporting tests for Johne’s disease. To show specific information relative to each test in a herd and to include all pertinent information concerning the results.
In addition, to facilitate the recording of uniform statistics information so t hat it will be readily available for special herd studies and program evaluation.
The instructions for the Continuation Johne’s Test Record, below are listed within the record.
1. Enter State postal code.
2. Enter the County’s name.
3. Premise ID number, owner number, and the kind of herds: Premise ID number is the code number for the herd, farm, ranch, dairy, or premises ID is to be recorded in
this block by the States that are maintaining a master identification file.
4. Owner’s Name and Address: Owner's Name and Address: In the top center portion of the form the herd owner's last name, first name, and middle initial should be prin ted
or legibly written.
5. Completed Herd Test of All Eligible Animals- The testing veterinarian should check the applicable block. When the “No” block is checked, the total number of eligible
animals in the herd should be recorded.
6. Sample Collection:
· Samples No: Identifies the sample with animal identification.
· Record all identification number(s):Record all Eartags(s) and Tattoo(s).
· Vacc Tattoo: If vaccinated, the vaccination tattoo should be recorded in this space.
· Age(DOB (mm/day/ yy): The month, day, and year the animal was born.
· Breed: Breed of Animal.
· Sex: M for Male or F for Female.
7. Test Results:
· ELISA: Enzyme-linked immunosobenent assay. Record result (S/P or OD valves) in the first column and the interpretation in the second column.
· Culture: Record colony counts or time to positive in the first column and the interpretation in the second column
· PCR: Polymerase chair reaction record quantitative results in the first column and the interpretation in the second column.
· Blank spaces: are for addition test that are requested.
· Other Test and Results:
8. Signature of Testing Veterinarian:
Certifying that the testing veterinarian have collected samples for each animal identified below and have a correctly listed each Sample number with completed
corresponding identification number all number and letters of all eartags have been listed, cattle with existing official eartags have not been retagged, and when payment is
claimed at program expensed in accordance with agreement number below, no payment has been or will be received from any other source.

The Veterinarian should transmit all records to the central office as soon as possible.