48 • Alternatives to Animal Use in Research, Testing, and Education 
Figure 3-1.— USDA/APHIS “Annual Report of Research Facility’ 5 
T nis icporl is reounea r>y law (7 USC 2143). Failure to report according to the regulations can 
result m an order to cease and desist and to be subject to penalties as provided for in Section 2150. 
UNITED STATES DEPARTMENT OF AGRICULTURE 
ANIMAL AND PLANT HEALTH INSPECTION SERVICE 
VETERINARY SERVICES 
DATE OF REPORT 
FORM APPROVED 
OMB NO. 0579*0036 
HEADQUARTERS RESEARCH FACILITY (\’ame & Address, at re 2 is - 
tcrcd with l ; Sl)A. include /.ip Code) 
ANNUAL REPORT OF RESEARCH FACILITY 
(Required l : or Ljch Repi>r(iny f acility li’herc Annuals Are Held 
Ami An Attending reterinarian Has Responsibility 
INSTRUCTIONS 
Reporting Facility • complete items 1 through 24 and submit to your 
Headquarters Facility. Attach additional sheets if necessary. 
REGISTRATION NO. 
REPORTING facility (Name and A ddrets. include /.ip Code f 
Headquarters Facility - complete items 25 tlirough 27 and submit on or before 
December 1 of each year for the preceding Federal fiscal year (October 1, to 
September 30} to the Veterinarian in Charge for the State where the research 
facility headquarters is registered. 
report of animals USED in actual research, testing. OR experimentation - Section 2.28 of Animal Welfare Regulations requires appro- 
priate use of anesthetics, analgesics, and tranquilizing drugs during research, testing, or experimentation. Experiments involving pain or distress without use of 
these drugs must be reported and a brief statement explaining the research. 
A. 
Animals Covered 
By Act 
B. 
New 
Animals 
Added this 
Year 
C. 
Number of animals used 
in research, experiments, 
or tests involving no pain 
or distress. 
D. 
Number of animals used 
in research, experiments, 
or tests where appropriate 
anesthetic, analgesic, or 
tranquilizer drugs were 
administered to avoid 
pain or distress. 
E. 
Number of animals used 
in research, experiments, 
or tests involving pain or 
distress without adminis- 
tration of appropriate 
anesthetic, analgesic, or 
tranquilizer drugs. 
(Attach brief explanation) 
F. 
TOTAL NO. 
Of Animals 
(Cols, f + C + D + E) 
5. Dogs 
6. Cats 
7. Guinea Pigs 
8. Hamsters 
9. Rabbits 
10. Primates 
11. Rats 
12. Mice 
^ Wild Animals (specify) 
14. 
15. 
CERTIFICATION BY ATTENDING VETERINARIAN FOR REPORTING FACILITY OR INSTITUTIONAL COMMITTEE 
I (We) hereby certify that the type and amount of analgesic, anesthetic, and tranquilizing drugs used on animals during actual research, testing or experimen- 
tation including post-operative and post-procedural care was deemed appropriate to relieve pain and distress for the subject animal. 
16. SIGNATURE OF ATTENDING VETERINARIAN 
17. TITLE 
1 8. DATE SIGNED 
1 9 . SIGN ATURE OF COMMITTEE MEMBER 
20. TITLE 
21. DATE SIGNED 
22. SIGNATURE OF COMMITTEE MEMBER 
23. TITLE 
24. DATE SIGNED 
CERTIFICATION BY HEADQUARTERS RESEARCH FACILITY OFFICIAL 
l certify that the above Is true, correct, and complete and that professionally acceptable standards governing the care, treatment, and use of animals including 
appropriate use of anesthetic, analgesic, and tranquilizing drugs, during actual research, testing, or experimentation Including post-operative and post-procedural 
care are being followed by the above research facilities or sites (7 U.S.C. Section 2143). 
25. SIGNATURE OF RESPONSIBLE OFFICIAL 
26. TITLE 
27. DATE SIGNED 
SOURCE: Animal and Plant Health Inspection Service, U.S. Department of Agriculture. 
