APHIS Form 2009 Center for Veterinary Biologics Inspection and Complianc

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 0579-0013. The time
required to complete this information collection is estimated to average 0.15 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
VETERINARY SERVICES

OMB Approved
0579-0013
EXP: XX/XXXX

CENTER FOR VETERINARY BIOLOGICS (CVB)
INSPECTION AND COMPLIANCE FACILITY
DOCUMENT SUBMISSION WORKSHEET

All buildings, appurtenances, and equipment used in the preparation of biological products shall be in compliance with Title 9, Code of Federal Regulations, Part 108, Facility
Requirements for Licensed Establishments. Completion of this worksheet facilitates review of facility documents submitted to CVB Inspection and Compliance.
1. USDA
VETERINARY BIOLOGICS
ESTABLISHMENT
NUMBER

2. ESTABLISHMENT A. ESTABLISHMENT NAME
SITE ADDRESS
RELATED TO
SUBMISSION
C. CITY

B. ADDRESS

D. STATE

E. COUNTRY

F. ZIP CODE

3. DATE SUBMITTED
4. DOCUMENTS SUBMITTED
A. TYPE OF DOCUMENT

CVB USE
ONLY

B. COMMENTS

5. MISCELLANEOUS DOCUMENT TYPE (not listed above)

6. COMMENTS
(Include pertinent information but be succinct,
maximum 200 characters. Do not repeat
information found elsewhere on this form.)

7. SUBMITTER SIGNATURE

A. SIGNATURE

B. DATE

(or liaison/alternate liaison)

FOR CVB USE ONLY
8. MAIL LOG NUMBER
9. CVB ACTION
10. APHIS REPRESENTATIVE SIGNATURE

APHIS FORM 2009
AUG 2017

A. DOCUMENTS FILED
A. SIGNATURE.

B. DOCUMENTS FILED,
REVISIONS REQUESTED

C. DOCUMENTS RETURNED
B. DATE