NAHMS-222 Goat 2009 Environmental Collection Record

Goat 2009
Environmental
Collection Record

Animal and
Plant Health
Inspection
Service
Veterinary
Services

¾

National Animal Health
Monitoring System
2150 Centre Ave, Bldg B
Fort Collins, CO 80526
Form Approved
OMB Number 0579-xxxx
Expiration date: xxx

Collect from Adult Goat Environments Only
State FIPS:

Operation
#:

2 digits

4 digits

Area

Primary Collector:

Date:

Initials

Kit # on
labels:

(mm/dd/yy)

Check the appropriate area for the sample collected.
Area 1 Area 2 Area 3 Area 4 Area 5 Area 6

Indoor structure, such
as barn
Outdoor pen or drylot
Pasture
Feed bunk area
Manure pile
Water trough
Milking area
(if applicable)
Entrance to or Exit from
milking area
Other – Specify location:

Other – Specify location:

Other – Specify location:

How many people in each category helped with the collection of the environmental samples?
_____ Fed VMO _____ Fed AHT _____ State Gov’t _____ Producer _____ Other (specify in margin)
How many hours did it take everyone to collect and prepare for shipping:

________ hours

How many round-trip hours did it take for everyone to get to the farm and back:

________ hours

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-xxxx. The time required to complete this information collection is estimated to average 0.5 hour
per response, including the time to review instructions, search existing data resources, gather the data needed, and complete
and review the information collected.

NAHMS-222
Nov 2008