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 numbers for these information collections 

are 0579-0040 and 0579-0245. The time required to complete this information collection is estimated to average .5 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.

This report is authorized by law or 

regulation (9 CFR 93). Failure to 

complete and sign the form will 

result in abandonment of birds.

OMB Approved

0579-0040 and 

0579-0245

UNITED STATES DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES

AGREEMENT OF PET BIRD OWNER

INSTRUCTIONS: Complete items 1 through 6 and the applicable Agreement A, B, and C. Distribute copies as identified

1. NAME AND ADDRESS OF OWNER (Include ZIP CODE) 2. DATE OFFERED FOR ENTRY

3. NUMBER OF BIRDS 4. COMMON NAME OF BIRDS

5. TRAVEL ROUTE OF IMPORTATION

6. OWNER’S AGREEMENT – SIGN A, B, C, OR D BELOW. (Refusal to sign this form automatically places option D into effect).

A Section A:

I do hereby declare that the pet birds identified above will be maintained in my personal possession, separate and apart from all other birds and poultry at the location 

indicated in item (1) below for a minimum of 30 days until released by an inspector of the Animal and Plant Health Inspection Service (APHIS) of the United States 

Department of Agriculture (USDA). If the birds must be moved. I agree to contact the official listed in item (2) below prior to such movement.

I do hereby agree that the bird(s) will be available for inspection during the aforementioned period of confinement at the address in item (1) below and at such times as 

deemed necessary by an inspector of APHIS, USDA. I further agree to immediately notify the Federal Official in item (2) below if any signs of disease are noted or if 

the bird(s) die during the confinement period.

I understand if a laboratory specimen is taken and if found to be infected with or exposed to a communicable disease of poultry, that the bird(s) will be disposed of by 

APHIS, USDA.

(1) LOCATION WHERE BIRDS WILL BE HELD (2) NAME AND ADDRESS OF FEDERAL OFFICIAL TO CONTACT

STATE PHONE NUMBER 

(Include Area Code)

SIGNATURE OF OWNER DATE SIGNED

LABORATORY SPECIMEN(S) TAKEN

SPECIMEN(S) SUBMITTED BY (Name) 

REFERRAL NUMBER

B Section B:

I certify that the birds have been in my possession for at least 90 days; that they are apparently healthy; and that they have not been exposed to any other birds 

during those 90 days.

SIGNATURE OF OWNER OWNER’S TELEPHONE NUMBER DATE SIGNED

AREA CODE PHONE NUMBER

WITNESSED BY (Signature) TITLE DATE SIGNED

C Section C: As the birds have not met the entry requirements for the U.S., I agree to export my birds to (Country).

SIGNATURE OF OWNER DATE SIGNED

D Section D: As the bird(s)/hatching eggs have not met the entry requirements for the U.S., I hereby abandon my bird(s)/hatching eggs to APHIS of USDA for disposal.

SIGNATURE OF OWNER DATE SIGNED

7. PORT OF ENTRY 8. CARRIER AND FLIGHT NO. FROM BIRD’S ITINERARY 9. VS FORM 17-30 DOCUMENT NUMBER

10. COMMENTS

I certify that I have, this day, inspected the bird(s) identified above offered for importation, and have found them to be free of evidence of communicable disease or exposure 

thereto, and release them for the purpose as stated above.

11. PORT RELEASING OFFICIAL (Signature) 12. TITLE 13. DATE SIGNED

I have inspected the bird(s) above, and find that all applicable provisions of 9 CFR Part 93, as amended, have been met.

14.FINAL RELEASING OFFICIAL (Signature) 15. TITLE 16. DATE RELEASED

VS FORM 17-8 (Previous editions are obsolete) 

JUL 2014