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The 77 043 form plays a crucial role in the safe and regulated transportation of certain animals, particularly in interstate and international contexts. It is designed to ensure that animals such as dogs, cats, and nonhuman primates are accompanied by a health certificate from a licensed veterinarian, thereby safeguarding their welfare and public health. This form is significant in compliance with the Paperwork Reduction Act of 1995, which stipulates the necessity of a valid OMB control number for such documentation. Individuals completing the form must provide various details, including the type of animal being shipped, the total number of animals, and the respective identification and vaccination history for each. A veterinary certification section is included, where a licensed veterinarian attests to the health status and vaccination history of the animals, confirming that they are free from infectious or contagious diseases. The form also outlines penalties for falsifying information, emphasizing its legal importance. Additionally, the document includes spaces for both the consignor and consignee’s details, ensuring clear communication between all parties involved in the transportation process. Understanding this form is vital for anyone involved in the shipment of animals, as it encompasses requirements and protections that align with USDA regulations.

77 043 Example

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

No dog, cat, nonhuman primate, or additional kinds or classes of animals designated by

OMB APPROVED

information unless it displays a valid OMB control number. The valid OMB control numbers for this information collection are 0579-0020 and 0579-0036.

USDA regulations shall be delivered to any intermediate handler or carrier for transportation

0579-0020

The time required to complete this information collection is estimated to average .13 to .25 hours per response, including the time for reviewing instructions,

in commerce unless accompanied by a health certificate executed and issued by a licensed

0579-0036

searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

veterinarian (7 U.S.C. 21.43.9; CFR, Subchapter A, Part 2).

 

 

WARNING: Anyone who makes

1.

TYPE OF ANIMAL SHIPPED (select one only)

2. CERTIFICATE NUMBER - OFFICIAL USE ONLY

UNITED STATES DEPARTMENT OF AGRICULTURE

a false, fictitious, or fraudulent

 

Dog

Cat

Other_________________

 

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

statement on this document, or

 

 

 

 

 

 

 

 

 

uses such document knowing it

 

Nonhuman Primate

Ferret

Rodent

 

UNITED STATES INTERSTATE AND INTERNATIONAL

to be false, fictitious, or

 

 

 

 

 

 

 

 

CERTIFICATE OF HEALTH EXAMINATION

fraudulent may be subject to a

 

 

 

 

 

 

3.

TOTAL NUMBER OF ANIMALS

 

4. PAGE

fine of not more than $10,000 or

 

FOR SMALL ANIMALS

imprisonment of not more than 5

 

 

 

 

 

 

 

years or both (18 U.S.C. 1001).

 

 

 

 

 

 

5. NAME, ADDRESS, AND TELEPHONE NUMBER OF OWNER (

CONSIGNOR)

6.

NAME, ADDRESS, AND TELEPHONE NUMBER OF RECIPIENT

AT DESTINATION (CONSIGNEE)

USDA License/or Registration Number (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. ANIMAL IDENTIFICATION

 

 

 

 

 

 

8. PERTINENT VACCINATION, TREATMENT, AND TESTING HISTORY

 

 

NAME, AND/OR TATTOO NUMBER

BREED – COMMON

 

 

COLOR OR

 

 

RABIES VACCINATION

 

 

OTHER VACCINATIONS,

 

OR SCIENTIFIC

AGE

SEX

DISTINCTIVE

 

 

 

 

 

TREATMENT, AND/OR TESTS AND RESULTS

OR OTHER IDENTIFICATION

 

MARKS OR

 

1 YEAR

2 YEARS

3 YEARS

 

NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

MICROCHIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vaccination Date

 

Product

Date

 

 

Product Type and/or Results

 

 

 

 

 

 

 

 

 

 

(1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(5)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(6)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. REMARKS OR ADDITIONAL CERTIFICATION STATEMENTS (WHEN REQUIRED)

 

VETERINARY CERTIFICATION: I certify that the animals described in box 7 have been examined by me this date, that the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

information provided in box 8 is true and accurate to the best of my knowledge, and that the following findings have been made

 

 

 

 

 

 

 

(“X” applicable statements).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have verified the presence of the microchip, if a microchip is listed in box 7.

 

 

 

 

 

 

 

 

 

 

 

I certify that the animal(s) described above and on continuation sheet(s), if applicable, have been inspected by me on this date and

 

 

 

 

 

 

 

appear to be free of any infectious or contagious diseases and to the best of my knowledge, exposure thereto, which would endanger the

 

 

 

 

 

 

 

animal or other animals or would endanger public health.

 

 

 

 

 

 

 

 

 

 

 

 

 

To my knowledge, the animal(s) described above and on continuation sheet(s) if applicable, originated from an area not quarantined

 

 

 

 

 

 

 

for rabies and has/have not been exposed to rabies.

 

 

 

 

 

 

ENDORSEMENT FOR INTERNATIONAL EXPORT (IF NEEDED)

 

 

 

 

NAME, ADDRESS, AND TELEPHONE NUMBER OF ISSUING VETERINARIAN

 

LICENSE NUMBER AND STATE

PRINTED NAME OF USDA VETERINARIAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accredited

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, please complete below

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NATIONAL ACCREDITATION NUMBER

 

 

 

 

 

 

 

NOTE: International shipments may require certification by an accredited veterinarian.

 

 

 

 

SIGNATURE OF USDA VETERINARIAN Apply USDA Seal or Stamp here

DATE

 

SIGNATURE OF ISSUING VETERINARIAN

 

 

 

 

 

DATE

APHIS Form 7001

 

(NOV 2010)

This certificate is valid for 30 days after issuance

Form Characteristics

Fact Name Description
Purpose The 77 043 form is used to certify the health of animals being shipped interstate or internationally.
Control Numbers This form must display valid OMB control numbers: 0579-0020 and 0579-0036.
Estimated Completion Time Completing the form typically takes between 0.13 to 0.25 hours, including time for reviewing instructions.
Governing Laws Regulations related to the form are governed by 7 U.S.C. 21.43.9 and CFR, Subchapter A, Part 2.
Penalties for Fraud Submitting false information may result in fines up to $10,000 or imprisonment for up to 5 years, according to 18 U.S.C. 1001.

Guidelines on Utilizing 77 043

Completing Form 77 043 is an important process that requires careful attention to detail. This form ensures that animals being shipped comply with health regulations set by the USDA. Below are the necessary steps to fill out this form correctly.

  1. Identify the Animal Type: In section 1, select one type of animal from the provided options (Dog, Cat, Nonhuman Primate, Ferret, Rodent, or Other).
  2. Enter the Certificate Number: Fill in the Certificate Number in the designated area labeled “OFFICIAL USE ONLY.”
  3. Input the Total Number of Animals: In section 3, write the total number of animals being shipped.
  4. Provide Owner’s Information: Enter the name, address, and telephone number of the animal owner (Consignor) in section 5.
  5. Fill in Recipient’s Details: In section 6, provide the name, address, and telephone number of the recipient at the destination (Consignee).
  6. Complete Animal Identification: For section 7, provide the animal’s identification, including breed, color, age, sex, and any distinctive marks or microchip information.
  7. Detail Vaccination and Treatment History: In section 8, outline pertinent vaccination, treatment, and testing history, ensuring to include dates and products used.
  8. Provide Additional Remarks: Write any remarks or additional certification statements in section 9 if required.
  9. Veterinary Certification: Ensure the veterinarian completes their certification, verifying examination and health status of the animals described.
  10. Endorsement for International Export: If exporting internationally, complete the endorsed section with the issuing veterinarian’s information and necessary details.
  11. Sign and Date: Make sure both the issuing veterinarian and USDA veterinarian sign and date the form accordingly.

Once the form is filled out, review each section for accuracy. It is crucial to ensure that all required information is complete before submission. This will help streamline the process and adhere to the regulations involved in the shipment of animals.

What You Should Know About This Form

What is the 77 043 form?

The 77 043 form is a document used for the health examination of certain animals before they are transported. It ensures the animals are free from infectious diseases and meet specific health requirements. The form is mandated by the United States Department of Agriculture (USDA) and is especially important for interstate and international shipments.

Who needs to complete the 77 043 form?

This form must be completed by a licensed veterinarian. The veterinarian examines the animals and certifies that they are healthy and vaccinations are up-to-date. Additionally, the form requires information from both the owner (consignor) and the recipient (consignee) of the animals.

How long does it take to fill out the 77 043 form?

The time to complete the 77 043 form is estimated to be between 8 to 15 minutes. This includes reviewing instructions, gathering necessary data, and filling in the required information. While this may seem quick, it is important that each section is completed accurately.

What types of animals are covered by the 77 043 form?

The form is designed for various types of animals, including dogs, cats, nonhuman primates, ferrets, and rodents. Only one type of animal is to be selected for each form to avoid confusion during transport.

Is there a penalty for providing false information on the 77 043 form?

Yes, there are serious penalties. If an individual submits false information, they may face a fine of up to $10,000 or imprisonment for up to five years. This law emphasizes the importance of honest and accurate reporting in the animal health certification process.

What should veterinary professionals include on the form?

Veterinary professionals should provide complete details about the animals being shipped. This includes their identification, vaccination records, treatment history, and any pertinent notes. They must sign the form to confirm the accuracy of the information and their assessment of the animals’ health.

How long is the 77 043 form valid for?

The 77 043 form is valid for 30 days from the date it is issued. It is important to ensure that the form is used within this timeframe to comply with transport regulations.

What happens if I need to ship animals internationally?

If you are shipping animals internationally, additional certifications may be required. An accredited veterinarian will need to sign off on the health of the animals, and you may need to include extra documentation. Always check the specific requirements for the destination country to ensure compliance.

Where can I find the OMB control numbers related to the 77 043 form?

You can find the valid OMB control numbers for the 77 043 form on the form itself. The control numbers are 0579-0020 and 0579-0036. These numbers indicate that the form has been approved and complies with the guidelines set by the Paperwork Reduction Act.

Common mistakes

Filling out the 77 043 form can be straightforward when you know what to watch out for. However, mistakes are common and can lead to delays or rejections. Here are eight mistakes people often make when completing this form.

First, many individuals do not read the instructions carefully. Skipping over the guidelines can lead to errors in the information provided. Each section has specific requirements, and missing even one can cause issues.

Another frequent error is failing to select the correct type of animal shipped. It is crucial to choose only one option from the list. Misclassifying the animal can result in compliance problems and additional scrutiny.

Some people neglect to provide accurate identification information. This includes details like the breed, color, and any unique identification marks. Incomplete or incorrect data can lead to misunderstandings and complications during transport.

Additionally, not including the necessary health certificates is a common pitfall. Animals being shipped must have documentation from a licensed veterinarian. Without this, the form may be deemed invalid.

Forgetting to include the veterinary certification can create significant issues as well. This section verifies that the animals have been examined and poses no health risk. A signature from the issuing veterinarian is essential for approval.

People also sometimes skip the vaccination history. The information about vaccinations, including the rabies vaccination, is critical. Missing these entries can delay processing time.

Moreover, neglecting to provide your contact information can hinder communication with the USDA. It's vital to ensure that both the consignor and consignee's details are complete and correct.

Lastly, waiting too long to submit the form can lead to complications. The certification is only valid for 30 days after issuance, so it's best to send it in early to avoid last-minute issues.

Documents used along the form

The 77 043 form serves as an essential document for the health examination of animals before they are transported across state or international borders. However, several other forms and documents are often used in conjunction with this form to ensure compliance with health and safety regulations. Below is a list of these documents, each described to provide a clearer understanding of their functions.

  • APHIS Form 7001: This form is often required for the interstate movement of animals. It serves as a health certificate issued by a veterinarian, affirming the health status of the animal and compliance with regulatory requirements.
  • Health Certificate: A document that certifies that the animal is free from contagious diseases and has received appropriate vaccinations. It is usually signed by a licensed veterinarian.
  • Import Permit: This permit may be necessary for bringing animals into a state or country. It specifies the conditions under which the importation can occur and ensures compliance with local regulations.
  • Veterinary Inspection Report: This report provides details about an animal's health status at the time of inspection. It assesses any potential health risks before transportation.
  • Rabies Vaccination Certificate: This specific certificate shows proof of rabies vaccination. It is especially critical for animals being transported across state lines or internationally.
  • Microchip Registration Document: This document confirms that the animal has been microchipped. It includes information about the microchip’s registration, which helps in identifying the animal.
  • Quarantine Documents: If an animal has been quarantined due to exposure to diseases, these documents would confirm the release from quarantine and any relevant health checks performed.
  • Transporter’s Permit: This permit is required for individuals or companies that transport animals commercially. It ensures the transporter complies with state and federal regulations.
  • Animal Transfer Agreement: This agreement outlines the terms under which the ownership or care of an animal is transferred from one party to another, including responsibilities for health and documentation.

These accompanying forms help facilitate safe and regulated animal transportation, ensuring that all parties are compliant with health and safety standards. Understanding the function of each document can aid in navigating the regulatory landscape involved in animal transport.

Similar forms

  • APHIS Form 7001: This form is also used for health certification of animals being transported. Like the 77 043 form, it requires a veterinary examination and contains information about the animals, including vaccination history.
  • USDA Animal Health Certificate: Similar to the 77 043, this document ensures that animals are free from disease before they are shipped. It requires details about the animal's health and vaccinations.
  • Embarkation Certificate: This document certifies animals are fit for travel and details their health status. It mirrors the 77 043 in terms of required veterinarian validation.
  • Health Certificate for International Movement: Used for animals being exported, this certificate is akin to the 77 043 as it mandates verification of health and vaccination by a licensed veterinarian.
  • Veterinary Certificate for Trade: When animals are sold or traded, this certificate provides proof of health similar to the requirements of the 77 043 for interstate movement.
  • Animal Passport: This document tracks the health status of pets traveling internationally. It includes health records much like the information required in the 77 043 form.
  • Intrastate Health Certificate: For animals moving within state lines, this certificate serves the same purpose as the 77 043, ensuring they are healthy and vaccinated.
  • USDA Export Certificate: This certificate is needed for animals exported from the U.S. and requires a health report akin to the one found on the 77 043 form.
  • Pet Health Certificate: When pets are relocated or travel, this certificate resembles the 77 043 by documenting their health and vaccination status to avoid issues during transport.

Dos and Don'ts

When filling out Form 77 043, it's important to follow certain guidelines to ensure accuracy and compliance. Here are some dos and don'ts to keep in mind:

  • Do select only one type of animal shipped to avoid confusion.
  • Do provide complete and accurate information for both the consignor and consignee.
  • Do ensure that the veterinary certification is signed and dated properly.
  • Do include all necessary vaccination history and treatment details relevant to the animals.
  • Don't leave any mandatory fields blank; incomplete forms can lead to delays.
  • Don't use false or misleading information anywhere in the form.
  • Don't assume knowledge about requirements; always review the instructions carefully.

Misconceptions

Misconception 1: The 77 043 form is only needed for dogs and cats.

This form is actually required for multiple species, including nonhuman primates, ferrets, and rodents. It's important to understand that various animals may need this certification when shipped.

Misconception 2: Anyone can fill out the 77 043 form.

Only a licensed veterinarian can certify the health of the animals on the form. This ensures that the information is accurate and reliable.

Misconception 3: The form is not mandatory if the animals are from a known source.

Regardless of the source, the 77 043 form is a requirement when transporting certain animals across state lines or internationally.

Misconception 4: The time to complete the form is lengthy and complicated.

In fact, it usually takes only about .13 to .25 hours to fill out the necessary information, making it manageable for veterinarians.

Misconception 5: The form does not need to include vaccination history.

Box 8 of the form specifically requires the vaccination and treatment history of the animals. This information is crucial for ensuring the health and safety of all animals involved.

Misconception 6: The 77 043 form is only necessary for international shipments.

This form is essential for both interstate and international transport of certain animals, not just for those going abroad.

Misconception 7: There are no penalties for submitting incorrect information.

Submitting false, fictitious, or fraudulent information can lead to serious consequences, including fines or imprisonment. It's crucial to ensure all details are accurate.

Misconception 8: You don’t need a veterinarian at the destination.

The form requires the name and contact details of a veterinarian at the destination, confirming that the receiving party is aware and prepared for the animal's arrival.

Misconception 9: A health certificate is not necessary if the animal looks healthy.

Even if an animal appears healthy, a licensed veterinarian must examine it and provide a certificate—this is to ensure public health and safety.

Misconception 10: This form is only for commercial transport.

While businesses often use it, private individuals shipping pets or animals also need the form, depending on the circumstances.

Key takeaways

Filling out and using the 77 043 form is essential for the transportation of certain animals. Here are key takeaways to keep in mind:

  • The form is necessary for complying with USDA regulations during the transportation of animals.
  • A valid OMB control number must appear on the form to ensure it meets legal requirements.
  • Careful attention to detail is crucial; errors or false information can lead to serious legal consequences, including hefty fines or imprisonment.
  • The estimated time for completing the form ranges from 0.13 to 0.25 hours, depending on individual preparation.
  • Documentation of vaccination and health certifications is essential for each animal being transported.