Ch. 3— Patterns of Animal Use • 61 
Figure 3-2.— Example A of APHIS “Annual Report of Research Facility” 
This report Is required by law (7 USC 2143). Faiiiv' report according to the regulations can 
result In an order to cease and des.st and to be sub/ o penalties as provided for in Section 21 50. 
UNITED STATES DEPARTMENT OF AGRICULTURE 
ANIMAL AND PLANT HEALTH INSPECTION SERVICE 
VETERINARY SERVICES 
1. DATE OF REPORT 
March 7, 1984 
FORM APPROVED 
OMB NO. 0579-0036 
ANNUAL REPORT OF RESEARCH FACILITY 
( Required For Each Reporting Facility Where Animals Are Held 
And An Attending Veterinarian Has Responsibility) 
2. HEADQUARTERS research facility (Same Address, as regis- 
tered with US DA, include Zip Code) 
INSTRUCTIONS 
3. registration no. 
Reporting Facility • complete items 1 through 24 and submit to your 
Headquarters Facility. Attach additional sheets if necessary. 
Headquarters Facility - complete items 25 through 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. 
4. reporting facility (Same and Address, include Zip Code) 
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. 
B. 
C. 
D. 
E. 
F. 
Animals Covered 
By Act 
New 
Animals 
Added this 
Year 
Number of animals used 
in research, experiments, 
or tests involving no pain 
or distress. 
. . 
Number of animals used 
in research, c;:parirr,er.ts, 
or tests where appropriate 
anesthetic, analgesic, or 
tranquilizer drugs were 
administered to avoid 
pain or distress. 
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) 
. 
TOTAL NO. 
Of Animals 
(Cols. B + C + D + E) 
5. Dogs 
610 
0 
610 
0 
1220 
6. Cats 
0 
0 
0 
n 
0 
7. Guinea Pigs 
0 
0 
0 
8. Hamsters 
0 
0 
0 
9. Rabbits 
24 
24 
0 
0 
48 
10. Primates 
0 
0 
0 
r> 
n 
11. Rats 
4500 
0 
4500 
0 
9000 
12. Mice 
2000 
1200 
800 
0 
4000 
WiitrAnrrm+s (specify) 
1 3 -Gerbils 
50 
0 
0 
0 
50 
^•Sheep 
8 
1 
7 
16 
^•Cattle 
10 
0 
10 
0 
20 
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 
3/s/y^ 
\9>sSI'GN ATJJflE/OF COMMITTEE MEMBER 
2o/tVM-E 
21. {3ATE SIGNED 
■J/ 6) 5f 
it. giGN*TURb\Of COMMITTEE MEMBER 
23. /TITLE * 
24. DATE SIGNED 
Jsh v 
CERTIFICATION BY HEADQUARTERS RESEARCH FACILITY OFFICIAL 
1 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). 
23. SIGNATURE OF RESPONSIBLE OFFICIAL 
26. TITLE 
27. DATE SIGNED 
VS FORM 18-23 Previous edition obsolete 
(AUG 81) 
SOURCE: Animal and Plant Health Inspection Service, U.S. Department of Agriculture. 
