Form VS 6-38 VS 6-38 ACCREDITED AREA SURVEILLANCE FOR TUBERCULOSIS

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 0579-00146. The time required to complete this information collection is estimated to average 10 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 APPROVED 0579-0146 Exp. xx/xx/xxxx

The information in this report is needed for effective monitoring and management of the Tuberculosis Federal-State Cooperative Program (9 CFR Part 77).

UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES ACCREDITED AREA SURVEILLANCE FOR TUBERCULOSIS

STATE

STATE CODE

YEAR

SECTION I – BOVINE POPULATION AND HERD STATUS

SECTION II – BOVINE POPULATION AND HERD STATUS

TYPE OF BOVINE

TOTAL HERDS A

TOTAL BOVINE B

TYPE OF BOVINE

TOTAL HERDS A

TOTAL BOVINE B

1. Dairy

9. Deer

2. Beef

10. Elk

3. Total Bovine Population (Lines 1+2)

11. All Other

4. Accredited Herds

12. Total Cervine Population (Lines 1+2+3)

5. Herds Under Quarantine

13. Accredited Herds

6. M.bovis Confirmed or Suspicious Herds

14. Qualified Herds

7. Total No Herds Quarantined During Year

15. Monitored Herds

8. Total No. Herds Released From Quarantine During Year

16. Herds Under Quarantine

SECTION III – SLAUGHTER WITHIN THE STATE

17. M.bovis Confirmed or Suspicious Herds

TOTAL BOVINE A

TOTAL CERVINE B

18. Total No. Herds Quarantined During Year

20. No. Slaughtered

19. Total No. Herds Released From Quarantine During Year

21. No. of VS 6-35s

BREAKDOWN OF 20A (Total Bovine)

BREAKDOWN OF 20B (Total Cervine)

22. Rate of VS 6-35 Submissions (Line 14 (divided by) Line 13 x 100,000)

23. Mature

26. Mature

24. All Other

27. All Other

25. TOTAL

28. TOTAL

29. BREAKDOWN OF ITEM 20A Federal Slaughter State Slaughter Both

30. BREAKDOWN OF ITEM 20B Federal Slaughter State Slaughter Both

SECTION IV – NAMES OF M.bovis CONFIRMED OR SUSPICIOUS HERDS (List each Herd show in Item 6A and 17A)

ACCREDITATION REQUEST

APPROVAL (Staff Use Only)

We certify that this area is being maintained under and complies with provisions of: The Uniform Methods and Rules governing Modified Accredited Status The Uniform Methods and Rules governing Accredited Free Status

This area is approved as a tuberculosis: MODIFIED ACCREDITED AREA ACREDITED FREE AREA

SIGNATURE OF STATE OFFICIAL

NAME OF STATE OFFICIAL (Please print or type)

DATE

SIGNATURE OF FEDERAL PRIVATE PRACTITIONER IN CHARGE

NAME OF FEDERAL V-I-C (Please print or type)

DATE

SIGNATURE OF VETERINARY SERVICES OFFICIAL

NAME OF V-S-O (Please print or type)

DATE

VS FORM 6-38 PAGE 1 OF 2

JUNE 2009

SECTION V – SPECIAL RETEST OF HIGH RISK HERDS (UM&R, PART X)

TESTS OF HERDS WITH M.bovis INFECTION CONFIRMED BUT HERD NOT DEPOPULATED

HERD OWNER

QUARANTINE RELEASE

1ST; 1 YR RETEST

2ND; 1 YR RETEST

3RD; 1 YR RETEST

4TH; 1 YR RETEST

5TH; 1 YR RETEST

1ST; 3 YR RETEST

2ND; 3 YR RETEST

TESTS OF HERDS WITH HISTORY OF LESIONS SUSPICIOUS OF M.bovis BUT NOT CONFIRMED

HERD OWNER

QUARANTINE RELEASED

1ST ANNUAL RETEST

2ND ANNUAL RETEST

OTHER

REPORT OF PREMISES WHERE A TUBERCULOSIS HERD WAS DEPOPULATED

HERD OWNER

DATE RESTOCKED

1ST RETEST (in 6 months)

2ND RETEST 1 YEAR AFTER 1ST

3RD RETEST 3 YRS AFTER 2ND

4TH RETEST 3 YEARS AFTER 3RD

VS FORM 6-38 (Reverse) PAGE 2 OF 2

JUNE 2009