C/7. 3— Patterns of Animal Use • 63 
Figure 3-4.— Example C of APHIS “Annual Report of Research Facility” 
K.EGC |eV>C D law (7 USC 2143). Failure to report according to the regulations can 
result in an order to cease and desist and to be subject to penalties as provided for in Section 2150. 
united states department of agriculture 
nprVNlOl/JQflQD PLANT HEALTH INSPECTION SERVICE 
WUW VETER1NARY SERV | CES 
t. DATE OF REPORT 
30 NOV 83 
FORM APPROVED 
OMB NO. 0579-0036 
USDA.MUIS.yS 
ANNUAL REPORT OF RESEARCH FACILITY 
(Required For Each Reporting Facility Where Animals Are Held 
And An Attending Veterinarian Has Responsibility) 
2. HEADQUARTERS research facility (A'amc * Aaaress. as regis- 
tered with USDA, include Zip Code) 
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 (frame and Address, include Zip Code ) 
report of animals used in actual research, testing, or experimentation - Section 2.28 of Animal Welfare Regulations reauires appro- 
priate use of anesthetics, analgesics, and tranauilizing 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 
44 
12 
189 
0 
201 
6. Cats 
0 
0 
0 
0 
0 
7. Guinea Pigs 
383 
137 
186 
0 
323 
8. Hamsters 
207 
0 
207 
0 
207 
9. Rabbits 
638 
40 
598 
0 
638 
10. Primates 
0 
12 
119 
0 
131 
11. Rats 
4357 
1940 
1444 
0 
3384 
12. Mice 
1373 
363 
739 
0 
1102 
Wild Animals ( specify ) 
13 ' TURTLES 
293 
0 
293 
0 
293 
14 ‘ DOMESTIC PIGS 
609 
0 
609 
0 
609 
l5 ' GERBILS 
100 
0 
100 
0 
100 
CERTIFICATION BY ATTENDING VETERINARIAN FOR REPORTING FACILITY OR INSTITUTIONAL COMMITTEE 
I (We) hereby certify that the type and amount of analgesic, anesthetic, and tranauilizing drugs used on animals during actual research, testing or experimen- 
tation including post-operative and. post-procedural-care/ waLdeemed appropriate to relieve pain and distress for the subject animal. 
16. SIGNATURE OF ATTENDING VETERIN/RfAf/ 
17. TITLE 
1 8. DATE SIGNED 
30 NOV 83 
19. SIGNATURE OF COMMITTEE MEMBER 
20. TITLE 
21. DATE SIGNED 
30 NOV 83 
22. SIGNATURE OF COMMITTEE^EMBER 
23. TITLE 
24 DATE SIGNED 
CERTIFICATION BY HEADQUARTERS RESEARCH FACILITY OFFICIAL 
1 certify that the above is trust correct, and complete and that professionally acceptable standards governing the care, treatment, and use of animals including 
appropriate use of anestneUd, analgesic, and tranguillzing drugs, During actual research, testing, or experimentation including post-operative and post-procedurai 
care are being followed O/The above research facilities or sites (7 U.S.C. Section 2143). 
23. SIGNATURE OS FItSFONSIBLE O/FICIAL 
26. TITLE 
27. DATE SIGNED 
30 NOV 83 
VS FORM 13-23 Previous edition obsolete 
(AUG 81) 
SOURCE: Animal and Plant Health Inspection Service, U.S. Department of Agriculture. 
