VS 6-22 Cooperative State - Federal Tuberculosis Eradication Pro

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OMB Approved
0579-0146
EXP. XX/XXXX

COOPERATIVE STATE - FEDERAL TUBERCULOSIS
ERADICATION PROGRAM

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

TUBERCULOSIS TEST RECORD

ALL INCOMPLETE RECORDS WILL BE RETURNED FOR COMPLETION
STATE

HERD OWNER - LAST NAME, FIRST MI

F
COUNTY

TWP

SEC

HERD OWNER COMPLETE ADDRESS

PREVIOUS
TEST DATE

VET CODE

TOTAL

REA

CERTIFICATION FOR PAYMENT

HERD NUMBER

SUS

DATE LISTED

STATE/FEDERAL EXPENSE
OWNER EXPENSE
D-B

COUNTY

U

TOWNSHIP OR DISTRICT

SECTION

YES
1

6

AREA

RETEST

HERD
2
(RE)ACCREDIT

TRACING
REG. KILL

7

MILK
ORDINANCE

3

TRACING
REACTORS

8

4

TRACING
EXPOSED

9

SALE SHOW
5
IMPORTED

FARM NUMBER

COMPLETE HERD TEST OF ALL
ELIGIBLE ANIMALS

REASON FOR TEST

10
OTHER

I certify that this test was made and read by me on each of the cattle
identified below on the dates and with the results as entered in appropriate
spaces, and that when payment is claimed at program expense in
accordance with agreement number below, no payment has been or will be
received from any other source.

NO

NO. ELIGIBLE ANIMALS
IN HERD:

PRACTIONER SIGNATURE

TELEPHONE

PRACTIONER NAME (print)

AGREE CODE

INJECTION

DATE

HOUR

OBSERVATION

DATE

HOUR

SUMMARY

NEGATIVE

KIND OF HERD
DEER

BISON

ELK

OTHER

SUSPECT

CATTLE

REACTOR

METHOD OF TEST

TUBERCULIN SERIAL NUMBER

CAUDAL FOLD
(CFT)

SNG CERVICAL
(CST) (CERVID)

CERVICAL
(CT) (BOVINE)

OTHER

TOTAL

BREED

SEX

NRS

1

AGE

SIZE

RESULTS
OFFICIAL
IDENTIFICATION NUMBER

RESULTS

1

OFFICIAL
IDENTIFICATION NUMBER

1.

13.

2.

14.

3.

15.

4.

16.

5.

17.

6.

18.

7.

19.

8.

20.

9.

21.

10.

22.

11.

23.

12.

RT – Retag
NA – Natural Addition
PA – Purchased Addition

VS Form 6-22
OCT 2016

AGE

BREED

SEX

NRS

TEST

SIZE

LESION

24.

N – Negative
S – Suspect
R - Reactor

I hereby acknowledge receiving a copy of this record which I have
examined and find correct.
OWNER SIGNATURE
DATE

(Previous editions are obsolete.)

THIS AUTHORIZATION
TO TEST EXPIRES: