Form CS347457-B Certification of Foreign Rabies Vaccination and Microchi

Certification of Dog Arriving from DMRVV*-free or Low-risk Country
(for Live Dog Importations into the United States)
*DMRVV= dog-maintained rabies virus variant
This form must be completed by the examining veterinarian and certified by
an official government veterinarian not more than 30 days before travel.
OMB Approval Number: 0920-1383
Form Expires: 05/31/2027

Form available at: www.cdc.gov/dogtravel

SECTION A: NAME, ADDRESS, PHONE NUMBER, AND EMAIL OF OWNER (CONSIGNOR)
Name:
Organization (if applicable):
City:

Address:
Zip Code (if in U.S.):

Region/State:
Phone Number (including country area code):

Country:

Email address:

SECTION B: NAME, ADDRESS, PHONE NUMBER, AND EMAIL OF RECIPIENT AT U.S. DESTINATION (CONSIGNEE)
Select if information is the same as section A
Name:
Organization (if applicable):
U.S. Address (cannot be PO Box):
City:

State:

Zip Code:

American
Alaska
Alabama
District
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Michigan
Massachusetts
Maryland
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
New
North
Northern
Puerto
Pennsylvania
Oregon
Oklahoma
Ohio
Rhode
South
U.S.
Virginia
Vermont
Utah
Texas
Tennessee
West
Washington
Wyoming
Wisconsin
Virgin
Hampshire
Jersey
Mexico
York
Virginia
Carolina
Dakota
Carolina
Dakota
Rico
Island
ofMariana
Columbia
Samoa
IslandsIslands

Phone Number (including country and/or area code):

Email address:

SECTION C: ANIMAL IDENTIFICATION

ANIMAL NAME

ISO-COMPLIANT
MICROCHIP NUMBER

-

-

-

ISO-COMPLIANT
MICROCHIP
IMPLANT DATE*
(MM/DD/YYYY)

-

BREED

SEX

DATE OF
BIRTH OR AGE
(MM/DD/YYYY)

COLOR/MARKINGS

Female
Male
Intact
Neutered
Intact
Neutered
*If implant date unknown, input earliest date when ISO-compliant microchip is documented on dog’s medical/vaccination
records.

SECTION D: OPTIONAL VACCINE INFORMATION**

PRODUCT NAME

MANUFACTURER

LOT NUMBER

PRODUCT
EXPIRATION DATE

DATE OF
VACCINATION

DATE NEXT
VACCINATION IS DUE

(MM/DD/YYYY)

(MM/DD/YYYY)

(MM/DD/YYYY)

**Attach foreign veterinary records or proof of payment for veterinarian services completed in the dog rabies-free or low-risk country at least six months prior to traveling to the
United States for certification by the official government veterinarian.

SECTION E: EXAMINING ± VETERINARIAN CERTIFICATION STATEMENT
1. I am authorized to practice veterinary medicine in the country of export.
2. I have verified the presence of an ISO-compliant microchip in the animal and the microchip number listed on this form is true and correct.
3. I have examined the animal presented to me and based on that examination I reasonably believe the animal to be over six months of age.
4. I have examined the animal presented to me and find that the age, breed, sex, and description of the animal listed on this form is true and
correct, and matches the information documented on the animal’s vaccination record (if provided).

Public reporting burden of this collection of information is estimated to average 15 minutes 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. An agency may
not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR
Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-1383
CS347457-B

5/2/2024

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ISO-COMPLIANT MICROCHIP NUMBER:

ANIMAL NAME:

-

-

-

-

5. I reasonably believe, based on my examination of the animal presented to me, that it appears at this time to be healthy and free of infectious
or contagious diseases, and to the best of my knowledge and belief, has not been exposed to any infectious or contagious diseases in the
past 30 days that would endanger the health of humans or other animals.
6. To the best of my knowledge and belief, the animal listed on this form has not been in a DMRVV high-risk country or in an area under
quarantine for rabies and has not been exposed to rabies in the past 6 months.
7. I hereby certify to the best of my knowledge and belief that that the dog’s veterinary medical information submitted herein (Sections C and D)
is complete and accurate.

SIGNATURE OF EXAMINING± VETERINARIAN THAT INSPECTED THE DOG:
I certify that all information provided on this form is true and accurate.
Printed Name and Title:
Address of Veterinarian:
City:

Region/State:

Telephone (including country code):

Country:
Email address:

License Number of Examining Veterinarian:

American
Algeria
Albania
Afghanistan
Anguilla
Angola
Andorra
Antigua
Antarctica
Bahamas,
Azores
Azerbaijan
Austria
Australia
Aruba
Armenia
Argentina
Bermuda
Benin
Belize
Belgium
Belarus
Barbados
Bangladesh
Bahrain
Bosnia
Bolivia
Bhutan
British
Brazil
Botswana
Burkina
Bulgaria
Brunei
Burma
Canary
Canada
Cameroon
Cambodia
Burundi
Cape
Cayman
Central
Christmas
China
Chile
Chad
Cocos
Congo,
Comoros
Colombia
Cook
Costa
Côte
Czech
Cyprus
Cuba
Croatia
Democratic
Dominican
Dominica
Djibouti
Denmark
Easter
El
Egypt
Ecuador
Equatorial
Falkland
Ethiopia
Eswatini
Estonia
Eritrea
Faroe
France
Finland
Fiji
French
Galapagos
Gabon
Gambia,
Gibraltar
Ghana
Germany
Georgia
Greenland
Greece
Grenada
Guadeloupe
Guam
Hong
Honduras
Haiti
Guyana
Guinea-Bissau
Guinea
Guatemala
Israel
Ireland
Iraq
Iran
Indonesia
India
Iceland
Hungary
Italy
Macau
Luxembourg
Lithuania
Liechtenstein
Libya
Liberia
Lesotho
Lebanon
Latvia
Laos
Kyrgyzstan
Kuwait
Kosovo
Kiribati
Kenya
Kazakhstan
Jordan
Japan
Jamaica
Madeira
Madagascar
Marshall
Malta
Mali
Maldives
Malaysia
Malawi
Martinique
Mayotte
Mauritius
Mauritania
Melilla
Micronesia,
Mexico
Montserrat
Montenegro
Mongolia
Monaco
Moldova
Morocco
Nepal
Nauru
Namibia
Mozambique
Netherlands
New
Niue
Nigeria
Niger
Nicaragua
Norfolk
North
Northern
Norway
Papua
Panama
Palau
Pakistan
Oman
Pitcairn
Philippines
Peru
Paraguay
Puerto
Portugal
Poland
Réunion
Qatar
Rwanda
Russia
Romania
Saint
San
Samoa
São
Saudi
Sierra
Seychelles
Serbia
Senegal
Solomon
Slovenia
Slovakia
Singapore
Somalia
South
Spain
Sri
Tanzania
Tajikistan
Taiwan
Syria
Switzerland
Sweden
Suriname
Sudan
Timor-Leste
Thailand
Tokelau
Togo
Trinidad
Tonga
Turks
Turkmenistan
Turkey
Tunisia
Ukraine
Uganda
Tuvalu
United
Vietnam
Venezuela
Vanuatu
Uzbekistan
Uruguay
Virgin
Zimbabwe
Zambia
Yemen
Salvador
Lanka
Marino
Tomé
(Including
Caledonia
Zealand
(New
d'Ivoire
Helena
Kitts
Lucia
Pierre
Vincent
Islands
Verde
Kong
(including
Korea
Macedonia
and
Islands,
Arabia
(mainland)
Rica
Islands
Africa
Georgia
Korea
Sudan
Leone
(U.S.)
Indian
and
(Keeling)
Republic
Island
Arab
Kingdom
States
New
(Myanmar)
Rico
SAR
and
Guiana
Polynesia
Island
Islands
African
Republic
Islands
(mainland)
Faso
and
(U.K.)
(France)
(New
Islands
and
Islands
(France)
The
(U.K.)
(including
Mariana
Islands
(U.K.)
(Including
Samoa
Caicos
Island
The
Guinea
and
and
Zealand)
(France)
(Denmark)
Republic
Ceuta
(U.K.)
Islands
Herzegovina
SAR
Republic
Federated
Guinea
(U.S.)
and
Emirates
(East
(China)
Barbuda
Antilles
(France)
Tobago
(Ivory
(U.K.)
Ocean
(New
(Chile)
and
(Denmark)
(Australia)
Zealand)
British
U.S.
Holy
-Nevis
(U.K.)
Príncipe
Republic
(France)
(Spain)
(France)
(U.K.)
West
(Portugal)
South
Islands
-(U.K.)
Miquelon
(China)
of
(Australia)
(France)
(Spain)
England
Northern
Scotland
Wales
Islands
the
Timor)
Coast)
Zealand)
Western
the
See,
Zanzibar)
-Territory
of
Bonaire
Curaçao
Saba
St.
-Grenadines
Bank
States
Sandwich
St.
the
(Australia)
Eustasius
Maarten
Vatican
-(U.S.)
(U.K.)
(France)
Barthelemy
Martin
Rota
Saipan
Tinian
Ireland
Congo
and
Sahara)
(U.K.)
of Gaza)
Island
Islands
City)

Date of examination§ (MM/DD/YYYY):

Veterinarian’s Signature:
The examining veterinarian must be authorized by the competent authority to practice veterinary medicine in the exporting country or be an official government veterinarian.
This certificate is valid for travel into the United States for 30 days from the date of examination.

±
§

SECTION F: ENDORSEMENT BY OFFICIAL GOVERNMENT VETERINARIAN IN EXPORTING COUNTRY
1. I certify that the veterinarian listed above holds a valid license to practice veterinary medicine in the country of export.
2. I certify I have reviewed all health records, microchip information, vaccination documents accompanying the animal and they are true and
correct to the best of my knowledge and belief.
3. I hereby certify to the best of my knowledge and belief that that the dog’s veterinary medical information submitted herein (Sections C and D) is
complete and accurate.

I certify that all information provided on this form is true and accurate.
ANIMAL NAME:

ISO-COMPLIANT MICROCHIP NUMBER:

-

-

-

-

Printed Name and Title:
Address of Official Government Veterinarian:
City:

Region/State:

Country:

Date (MM/DD/YYYY):

Official Government Veterinarian’s Signature:

American
Algeria
Albania
Afghanistan
Anguilla
Angola
Andorra
Antigua
Antarctica
Bahamas,
Azores
Azerbaijan
Austria
Australia
Aruba
Armenia
Argentina
Bermuda
Benin
Belize
Belgium
Belarus
Barbados
Bangladesh
Bahrain
Bosnia
Bolivia
Bhutan
British
Brazil
Botswana
Burkina
Bulgaria
Brunei
Burma
Canary
Canada
Cameroon
Cambodia
Burundi
Cape
Cayman
Central
Christmas
China
Chile
Chad
Cocos
Congo,
Comoros
Colombia
Cook
Costa
Côte
Czech
Cyprus
Cuba
Croatia
Democratic
Dominican
Dominica
Djibouti
Denmark
Easter
El
Egypt
Ecuador
Equatorial
Falkland
Ethiopia
Eswatini
Estonia
Eritrea
Faroe
France
Finland
Fiji
French
Galapagos
Gabon
Gambia,
Gibraltar
Ghana
Germany
Georgia
Greenland
Greece
Grenada
Guadeloupe
Guam
Hong
Honduras
Haiti
Guyana
Guinea-Bissau
Guinea
Guatemala
Israel
Ireland
Iraq
Iran
Indonesia
India
Iceland
Hungary
Italy
Macau
Luxembourg
Lithuania
Liechtenstein
Libya
Liberia
Lesotho
Lebanon
Latvia
Laos
Kyrgyzstan
Kuwait
Kosovo
Kiribati
Kenya
Kazakhstan
Jordan
Japan
Jamaica
Madeira
Madagascar
Marshall
Malta
Mali
Maldives
Malaysia
Malawi
Martinique
Mayotte
Mauritius
Mauritania
Melilla
Micronesia,
Mexico
Montserrat
Montenegro
Mongolia
Monaco
Moldova
Morocco
Nepal
Nauru
Namibia
Mozambique
Netherlands
New
Niue
Nigeria
Niger
Nicaragua
Norfolk
North
Northern
Norway
Papua
Panama
Palau
Pakistan
Oman
Pitcairn
Philippines
Peru
Paraguay
Puerto
Portugal
Poland
Réunion
Qatar
Rwanda
Russia
Romania
Saint
San
Samoa
São
Saudi
Sierra
Seychelles
Serbia
Senegal
Solomon
Slovenia
Slovakia
Singapore
Somalia
South
Spain
Sri
Tanzania
Tajikistan
Taiwan
Syria
Switzerland
Sweden
Suriname
Sudan
Timor-Leste
Thailand
Tokelau
Togo
Trinidad
Tonga
Turks
Turkmenistan
Turkey
Tunisia
Ukraine
Uganda
Tuvalu
United
Vietnam
Venezuela
Vanuatu
Uzbekistan
Uruguay
Virgin
Zimbabwe
Zambia
Yemen
Salvador
Lanka
Marino
Tomé
(Including
Caledonia
Zealand
(New
d'Ivoire
Helena
Kitts
Lucia
Pierre
Vincent
Islands
Verde
Kong
(including
Korea
Macedonia
and
Islands,
Arabia
(mainland)
Rica
Islands
Africa
Georgia
Korea
Sudan
Leone
(U.S.)
Indian
and
(Keeling)
Republic
Island
Arab
Kingdom
States
New
(Myanmar)
Rico
SAR
and
Guiana
Polynesia
Island
Islands
African
Republic
Islands
(mainland)
Faso
and
(U.K.)
(France)
(New
Islands
and
Islands
(France)
The
(U.K.)
(including
Mariana
Islands
(U.K.)
(Including
Samoa
Caicos
Island
The
Guinea
and
and
Zealand)
(France)
(Denmark)
Republic
Ceuta
(U.K.)
Islands
Herzegovina
SAR
Republic
Federated
Guinea
(U.S.)
and
Emirates
(East
(China)
Barbuda
Antilles
(France)
Tobago
(Ivory
(U.K.)
Ocean
(New
(Chile)
and
(Denmark)
(Australia)
Zealand)
British
U.S.
Holy
-Nevis
(U.K.)
Príncipe
Republic
(France)
(Spain)
(France)
(U.K.)
West
(Portugal)
South
Islands
-(U.K.)
Miquelon
(China)
of
(Australia)
(Spain)
(France)
England
Northern
Scotland
Wales
Islands
the
Timor)
Coast)
Zealand)
Western
the
See,
Zanzibar)
-Territory
of
Bonaire
Curaçao
Saba
St.
-Grenadines
Bank
States
Sandwich
St.
the
(Australia)
Eustasius
Maarten
Vatican
-(U.S.)
(U.K.)
(France)
Barthelemy
Martin
Rota
Saipan
Tinian
Ireland
Congo
and
Sahara)
(U.K.)
of Gaza)
Island
Islands
City)

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