Form APHIS 453 APHIS 453 Program Site Tag Information Sheet

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 0579-0327. The time required
to complete this information collection is estimated to average .25 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
1. STATE

OMB Approved
0579-0327
EXP.: XX/XXXX

PROGRAM SITE TAG INFORMATION SHEET
2. DATE

3. LOCATION ADDRESS (Include ZIP Code)

4. REQUESTOR

5. TELEPHONE NUMBER

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6. TYPE OF TAG (Check the appropriate box)

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Backtag Cattle
Backtag Swine
I/D Tag Cattle
I/D Tag Swine

Vaccination Tag
Reactor Tag BR
Reactor Tag TB
Bangle Tag

Other (Specify) ________________________________________________________________________________________________________

7. SINGLE/DUPLICATE TAG

8. ASSIGNED LETTER CODE

9. ROLLOVER TAG

9.b. EXCLUSIONS (I, O, etc.,)

9.c. BEGIN WITH LETTERS

12. GLUE CONTAINER

13. MAXIMUM ISSUE

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9.a. ROLLOVER SEQUENCE (1 Roll/2 Roll)

Yes
No

10. YEARLY USAGE (HDS Sets)

14. REMAINING STOCK

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Use Stock Until Depleted

11. MAXIMUM ISSUE PER ORDER

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Destroy Stock

15. OTHER

16. NEW NATIONAL STOCK NUMBER (NSN) (To be assigned)

APHIS 453-R
APR 2014

Old Stock Number ________________________________________________