62 • Alternatives to Animal Use in Research, Testing, and Education 
Figure 3-3.— Example B of APHIS “Annual Report of Research Facility” 
This report Is required by law (7 USC 2143). Failure to report according to the regulations can 
•esult in 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 
1. DATE OF REPORT 
10/17/83 
FORM APPROVED 
OMB NO. 0579-0036 
2. HEADQUARTERS RESEARCH FACILITY (Name & Address, as regis- 
tered with USDA, include Zip Code) 
ANNUAL REPORT OF RESEARCH FACILITY 
(Required For Each Reporting Facility Where Animals Are Held 
And An Attending Veterinarian Has Responsibility) 
INSTRUCTIONS 
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. 
3. REGISTRATION NO. 
4. REPORTING FACILITY (Name and Address, include Zip Code I 
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. + C + D + E) 
5. Dogs 
l^t 
]k 
6. Cats 
6 
6 
12 
7. Guinea Pigs 
18 
18 
36 
8. Hamsters 
, 
9. Rabbits 
130 
130 
260 
10. Primates 
1 1-. Rats 
20 
20 
AO 
12. Mice 
250 
250 
■ ,V.: ..... 
500 
Wild Animals (specify) 
13. 
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 tranqulllzlng 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 ATIENDING VETERINARIAN 
17. TITLE 
1 8. DATE SIGNED 
19. SlOtrtTTURE OF dOMKIITTEE MEMBER 
20. TITLE 
21. DATE SIGNED 
22. SIGNATURE OF COMMITTEEAlgMBER 
23. TITLE 
24. DATE SIGNED 
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-ar^ being followed by the above research facilities or sites (7 U.S.C. Section 2143). 
2E. SIGNATURE OF^Hg^t^WSTBl^jltfFFICIAL 
26. TITLE 
27. DATE SIGNED 
/<?- 3) f3 
VS FORM 18-23 Previous edition obsolete 
(AUG 81) 
SOURCE: Animal and Plant Health Inspection Service, U.S. Department of Agriculture. 
