VS 4-12 National Veterinary Services Laboratories Kit and Instru

Clear Form
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 0579-0430. The time required to complete this
information collection is estimated to average 2 minutes per response, including the time for reviewing instructions, search 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
0579-0430
Exp. XX/XXXX

NATIONAL VETERINARY SERVICES LABORATORIES
KIT AND INSTRUMENT ORDER FORM

CONTACT NAME:
ORGANIZATION COMPANY:
ADDRESS (do not use a P.O. Box) CITY, STATE, ZIP CODE:
TELEPHONE NUMBER:

DATE OF REQUEST:

ITEM

QUANTITY

ITEM

BSE FRESH TISSUE

DIAGNOSTIC KITS

KIT #5 (5 red-top tubes)

LARGE

KIT #10 (10 red-top tubes)

SMALL

QUANTITY

KIT #25 (25 red-top tubes)
SCRAPIE (Formalin)

INSTRUMENTS

KIT #1 (2-180 ml jars)

SPOONS, SMALL

KIT #2 (12-180 ml jars)

SPOONS, LARGE

KIT #3 (2-90 ml jars)

FORCEPS (rat tooth)

KIT #4 (12-90 ml jars)

METZENBAUM SCISSORS (curved nose)

TB KITS

DRESSING SCISSORS (straight nose)

SLAUGHTER (black/yellow)

SCALPELS (10 per box)

DEER (orange)

RECTAL SPECULUM

MEDIA

MISCELLANEOUS KITS

TBTB 5 ml (10/box)

FADD REPLENISHMENT

TBTB 3 ml (each)
3 ml BHI BROTH (40 tubes/box; no antibiotics)

(Blue cap/plastic tube. For up to 5 swabs OP/CL swab pools from
avian spp. See NVSL WI-AV-0020 for details.)

AI KITS

5.5 ml BHI BROTH WITH ANTIBIOTICS (40 tubes/box)

(Black cap/plastic tube. For up to 11 TR/OP swab pools from
gallinaceous poultry or environmental sample collection;
Refer to NVSL WI-AV-0020 for further details.)

COLLECTION KIT (STP 210)

FORMALIN CASE SIZE

MISCELLANEOUS ITEMS

90 ml (96/case)

AI BAR CODES (4/set) (Specify roll or set)

180 ml (64/case)

BSE BAR CODES (8/set) (Specify roll or set)
TISSUE CASSETTE
BIOPSY SPONGES

Fax all supply orders to NVSL Shipping Department at 515-337-7378 or email to NVSLShipping@usda.gov.
The NVSL Shipping Department may be reached at NVSLShipping@usda.gov.
Safety data sheets may be obtained at
https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/sa_lab_information_services/sa_reagents/ct_safety
Please make a copy of all orders for your records.
VS FORM 4-12
FEB 2021