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 1 hour 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. |
OMB Approved 0579-0430 Exp. 02/2025 |
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United States Department of Agriculture Animal and Plant Health Inspection Service Veterinary Services |
NVSL Contact Information Update |
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Name of Business/Laboratory (Required):
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Business type:
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Address 1:
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Address 2:
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City:
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State/Province:
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Postal Code: |
Country:
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Business Phone Number (Required):
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Business Fax Number (Optional): |
Business Premises ID:
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Business Email Address(s) (To be included in all reports associated with this business):
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Individuals Authorized to Submit and Incur Expenses Under this Business (Select Individual and Enter Contact Information) |
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Individual: ☐ Veterinarian ☐ Biologist ☐ Animal Health Technician ☐ Other (Specify) |
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Salutation:
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First Name: |
Middle Name:
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Last Name:
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Individual Email Address(s) (To be included in all reports submitted): |
Phone Number: |
National Veterinary Accreditation Number (Optional): |
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Individual: ☐ Veterinarian ☐ Biologist ☐ Animal Health Technician ☐ Other (Specify) |
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Salutation:
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First Name: |
Middle Name:
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Last Name:
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Individual Email Address(s) (To be included in all reports submitted):
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Phone Number: |
National Veterinary Accreditation Number (Optional): |
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Individual: ☐ Veterinarian ☐ Biologist ☐ Animal Health Technician ☐ Other (Specify) |
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Salutation:
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First Name: |
Middle Name:
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Last Name:
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Individual Email Address(s) (To be included in all reports submitted):
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Phone Number: |
National Veterinary Accreditation Number (Optional): |
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Individual: ☐ Veterinarian ☐ Biologist ☐ Animal Health Technician ☐ Other (Specify) |
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Salutation:
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First Name: |
Middle Name:
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Last Name:
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Individual Email Address(s) (To be included in all reports submitted):
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Phone Number: |
National Veterinary Accreditation Number (Optional): |
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Individual: ☐ Veterinarian ☐ Biologist ☐ Animal Health Technician ☐ Other (Specify) |
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Salutation:
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First Name: |
Middle Name:
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Last Name:
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Individual Email Address(s) (To be included in all reports submitted):
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Phone Number: |
National Veterinary Accreditation Number (Optional): |
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Comments/Additional Instructions:
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□ This record is no longer needed; remove it from your active files. |
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Return updated forms via one of the following ways: Email:
NVSL.info@usda.gov Mail: USDA/APHIS/VS/National Veterinary Services Laboratories | Attn: LIMS Contact Update | 1920 Dayton Ave. | Ames, IA 50010 |
VS
FORM 4-10
JUN 2024
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | kahardy |
File Modified | 0000-00-00 |
File Created | 2024-09-21 |