Get 16 3 2012-2024

U.S. USDA Form usda-vs-16-3 Failure to supply all applicable information can delay the processing of this a pplication. No controlled material organisms or vectors may be imported or moved interstate unless the data requested on this form is furnished and certified 9 CFR 94 95 and 122. 0579-0015 1. MODE OF TRANSPORTATION Please X AIR SEA LAND ANY 2. U.S. Ports of Entry IMPORT OR TRANSPORT CONTROLLED MATERIAL OR ORGANISMS OR VECTORS 3. IMPORTER Name organization complete address telephone and fax 4. SHIPPER s Name and Address of producer/shipper number of individual who will receive and be responsible for the imported material 5. DESCRIBE THE MATERIAL TO BE IMPORTED Provide the following information as applicable Animal species and tissue of origin of animal product country of origin of the animals from which the raw animal product was sourced processing country recombinant system and genetic inserts antibody immunogens stabilizers nutritive factors of animal origin in media. COMPLETE VS FORM 16-7 for cell cultures and their products 6. PLEASE TYPE OR PRINT CLEARLY According to the Paperwork Reduction Act of 1995 no persons are 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 0579-0015. The time required to complete this information collection is estimated to average between 1. 6 and 3 hours 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* U*S* DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES National Center for Import-Export Products Program 4700 River Road Unit 40 Riverdale MD 20737-1231 APPLICATION FOR PERMIT TO FORM APPROVED OMB NO. 0579-0015 1. MODE OF TRANSPORTATION Please X AIR SEA LAND ANY 2. U*S* Ports of Entry IMPORT OR TRANSPORT CONTROLLED MATERIAL OR ORGANISMS OR VECTORS 3. IMPORTER Name organization complete address telephone and fax 4. SHIPPER s Name and Address of producer/shipper number of individual who will receive and be responsible for the imported material 5. DESCRIBE THE MATERIAL TO BE IMPORTED Provide the following information as applicable Animal species and tissue of origin of animal product country of origin of the animals from which the raw animal product was sourced processing country recombinant system and genetic inserts antibody immunogens stabilizers nutritive factors of animal origin in media* COMPLETE VS FORM 16-7 for cell cultures and their products 6. QUANTITY FREQUENCY OF IMPORTATION AND EXPECTED COMPLETION DATE estimate 7. PROPOSED USE OF MATERIALAND DERIVATIVES Also for animal pathogens or vectors describe facilities/biosafety procedures 8. IF FOR USE IN ANIMALS SPECIFY SPECIFY THE ANIMAL SPECIES 9. TREATMENT OF MATERIALPRIO PRIOR R TO IMPORTATION INTO THE U*S* Processing/purification methods including time at specific temperatures pH other treatments disease safeguard etc* 10.