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 0579-0101. The time required to complete this information collection 

is estimated to average .16 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.

OMB APPROVED

0579-0101

U.S. DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES

APPLICATION FOR THE SCRAPIE FREE FLOCK CERTIFICATION PROGRAM (SFCP)

Flock ID Owner Name, Address and Email Address Flock Location(s) if Different

Premises ID

Telephone

Number of Animals in Flock:

I, ________________________________________ agree to abide by the provisions of the Scrapie Free Flock Certification Program (SFCP)

standards for participation in the Select / Export Category (circle one) including the following:

A. To report scrapie suspect animals and animals suspected of other neurologic and chronic debilitating (prolonged wasting) illnesses to a State 

Animal Health Official, Veterinary Services representative, or an accredited veterinarian, and to ensure that proper tissue samples are 

collected and submitted for diagnostic purposes. Such animals shall not be used for breeding or disposed of without the prior approval of a 

State or APHIS representative

B. To officially identify all animals in accordance with the SFCP standards for the Select / Export Category (circle one).

C. To maintain records in accordance with the SFCP standards for the Select / Export Category (circle one).

D. To allow breed associations and registries, livestock markets, and packers to disclose records to Veterinary Services representatives or State 

Animal Health Officials. These records will be used to trace a source of exposure and other exposed animals.

E. Tissues from scrapie suspect animals, animals suspected of other neurologic and chronic debilitating (prolonged wasting) illnesses, and any 

other animal required by the program standards will be submitted to an official laboratory, in accordance with part V and appendix 1 of the 

SFCP standards. Other tissues will be submitted in accordance with the requirements at the request of the State or Federal animal health 

official.

F. Additionally, for Export category participants

1. Ensure that tissues are collected from all mature animals found dead in a timely manner for testing for scrapie.

2. To notify the State Scrapie Certification Board and/or the Veterinary Services Area Office within 30 days of any action resulting in a 

change in status or status date such as the acquisition of and/or commingling with nonparticipating animals or embryos, animals or 

embryos with a lower status or status date, or use of sheep or goat milk or colostrum or products derived therefrom.

3. To make animals and records available for inspection by Veterinary Services representatives, State Animal Health Officials and State

Scrapie Certification Board representatives, given reasonable prior notice. To have the necessary facilities and personnel available to

assist in inspecting the identification of each animal and the records. To schedule a flock inspection every 11 – 13 months based on the

enrollment date.

4. An inventory of animals in the flock, including official ID, species, breed or type, sex, and age of each animal is attached.

I furthermore acknowledge that Veterinary Services will publish my status on the APHIS public website, including the following information: 

the number of animals tested for scrapie; enrollment date; and, when applicable, my status date.

Remarks

State Representative’s Signature Date Owner’s Signature Date

Veterinary Services Representative’s Signature Date State Scrapie Certification Board Representative’s Signature, 

if different than State and VS representatives

Date

VS FORM 5-22 (Previous editions are obsolete)

JUNE 2013