NAHMS 471 On-Farm Monitoring of Antimicrobial Use and Resistance i

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-XXXX. The time required to complete this information collection is
estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review
the information collected.

OMB Approved
0579-XXXX
EXP: XX/XXXX

ON-FARM MONITORING OF
ANTIMICROBIAL USE AND
RESISTANCE IN U.S. BROILER
PRODUCTION SURVEY

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
NATIONAL ANIMAL HEALTH MONITORING SYSTEM
2150 CENTRE AVE, BLDG B
FORT COLLINS, CO 80526

FARM ________________

QUARTER __________

All data entered below are for the HOUSE that is being sampled.

DATE PLACED

DATE SAMPLED

NUMBER PLACED

7-DAY MORTALITY

PLANNED AGE OF
SLAUGHTER

DOWNTIME FROM PRIOR
FLOCK

Was litter reused? (circle one)

YES

NO

If yes, how many times?

Was in-ovo gentamicin used? (circle one)

YES

NO

If yes, dose per bird?

Were antibiotics / ionophores used in the feed? (circle one)

YES

NO

IONOPHORES
DRUG

DOSE (g/ton)

STARTING AGE

DURATION (days)

ANTIBIOTICS IN FEED (feed efficiency / disease prevention)
DRUG

INDICATION

DOSE (g/ton)

STARTING AGE

DURATION (days)

ANTIBIOTICS FOR DISEASE TREATMENT AND CONTROL (water or feed)
DRUG

NAHMS FORM 471
JUN 2021

INDICATION

Route (W / F)

TOTAL AMOUNT

STARTING AGE

DURATION