VS 6-22C Tuberculin Test Record (Special)

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 0579-0146. The time required to complete this information collection is estimated to average .42 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and
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UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
HERD OWNER - LAST NAME, FIRST MI

TUBERCULIN TEST RECORD (Special)
REASON FOR CFT OR SCT

DATE INJECTED

1
AREA
ROUTE - STREET - ROAD

HERD
(RE)ACCREDIT

2

7

STATE (including ZIP Code)

4

NEG

9

5
SECTION

CC TEST RESULTS
SUS

REA

1ST
TOTAL

TRACING EXPOSED

IMPORTED
TOWNSHIP

COMPARATIVE RETEST

8
TRACING REACTORS

SALE - SHOW

COUNTY

COMPARATIVE CERVICAL COMPLETE HERD
NO. OF ELIGIBLE
TEST OF ALL ELIGIBLE ANIMALS IN HERD
ANIMALS
IF “NO”
RETEST OF CFT/SCT SUSPECTS
YES
NO
YES
NO

TRACING REG. KILL
3

CFT OR SCT TEST

CFT OR SCT

6
HERD RETEST

MILK ORDINANCE
POST OFFICE

OMB APPROVED
0579-0146
EXP. XX/XXXX

10

TUBERCULIN

OTHER

HERD NO.

SERIAL NO.

2ND

KIND OF HERD
DEER

BISON

ELK

OTHER

CATTLE

_______________________

LOCATION OF CC TEST

AVIUM

RIGHT SIDE OF NECK

ANIMAL
NUMBER

BOVIS

OFFICIAL
IDENTIFICATION
NUMBER

AVIUM PPD
(UPPER)
OTHER
IDENTIFICATION

AGE

BREED

SEX

SKIN THICKNESS
mm
NORMAL

mm
mm
72 HOURS INCREASE

BOVIS PPD
(LOWER)
SKIN THICKNESS
mm
NORMAL

mm
mm
72 HOURS INCREASE

LEFT SIDE OF NECK

PREVIOUS CLASSIFI CFT OR
CATION
SCT
(CC TEST)
RESPONSE (N S R)

REMARKS

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SIGNATURE

VS FORM 6-22C
OCT 2016

TITLE

DATE

(Previous editions are obsolete.)