Verification of Service Dog Immunization

Requirement to Present Certain Health Information for a Service Dog under 38 CFR 1.218(a)(11)

OMB No. 2900-0831
Estimated Burden: 5 minutes

Expiration Date: XX/XX/XXXX

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 5 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to achieve health care services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

Verification of Service Dog Immunization

Due to substantial risk in allowing Veteran service animals in residential treatment settings for extended periods of time without proper documentation of vaccination, pursuant to 38 U.S.C. 901, The Department of Veterans Affairs (VA) will collect information verifying the vaccination status of canine animals visiting any VA Campus for extended periods. VA will collect information on the individual canines’ health demonstrating immunization from Adenovirus-2, Distemper, Parvovirus, Rabies, and other viral diseases. For those canines involved in Veteran activities (AAA) and involved in Veteran therapy programs (AAT), VA will request general health information demonstrating the canine has been provided core vaccinations, any prior use of prophylactic parasite control meds, and documented proof of regular health screenings.

VA Form 10-5344

June 2015