AnimalHealth - Highly Pathogenic Avian Influenza Permit Request

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DEPARTMENT OF AGRICULTURE - DIVISION OF ANIMAL HEALTH

HPAI Permit Request Form

Permitting Procedure for Importation of Poultry, Hatching Eggs or Poultry Waste from Highly Pathogenic Avian Influenza (HPAI) States

Only poultry or hatching eggs moving into New Jersey live bird markets, from HPAI states, require a permit and 72-hour test. The collection date, collection time, laboratory result, laboratory accession number and laboratory name must be recorded on the CVI accompanying the shipment. A copy of the laboratory report must also accompany the shipment. No poultry waste shall be imported from HPAI states, without prior approval and permit issued by the State Veterinarian. For information about testing please refer to the N.J.A.C. 2:3-7.4 (b) at http://www.nj.gov/agriculture/divisions/ah/pdf/NJACChapter3.pdf

This form is to be used to facilitate the receipt of information. Submission of this form is not a permit for movement.

Please call the Division of Animal Health at 609-671-6400 with any questions.

 

“Permit applications and test results must be submitted online by 7 PM on behalf of registered poultry distributors. Weekend 72-hour permit applications will not be reviewed on Sundays. All permit applications must be received on Saturday by 7 PM for anticipated movement on the subsequent Monday. Please note that poultry destined for the NJ Live Bird Marketing System may not be imported into NJ unless negative AI results have been submitted to the Division of Animal Health and the poultry distributor is in receipt of a permit number from the Division of Animal Health via e-mail provided in the online permit application.”

 

* REQUIRED FIELD

Caller/Requester Information

Example: Poultry from a PA control area moving to New York, then entering NJ LBM system

Shipment Origin

Premises Physical Location
Premises Mailing Address (if different from premises physical location above)

Shipment Information

Shipment Destination

Shipment Destination #1
Premises Physical Location #1
Premises Mailing Address #1 (if different from premises physical location)
Shipment Destination #2
Premises Physical Location #2
Premises Mailing Address #2 (if different from premises physical location)
Shipment Destination #3
Premises Physical Location #3
Premises Mailing Address #3 (if different from premises physical location)
Shipment Destination #4
Premises Physical Location #4
Premises Mailing Address #4 (if different from premises physical location)
Shipment Destination #5
Premises Physical Location #5
Premises Mailing Address #5 (if different from premises physical location)
Shipment Destination #6
Premises Physical Location #6
Premises Mailing Address #6 (if different from premises physical location)
Shipment Destination #7
Premises Physical Location #7
Premises Mailing Address #7 (if different from premises physical location)
Shipment Destination #8
Premises Physical Location #8
Premises Mailing Address #8 (if different from premises physical location)
Shipment Destination #9
Premises Physical Location #9
Premises Mailing Address #9 (if different from premises physical location)
Shipment Destination #10
Premises Physical Location #10
Premises Mailing Address #10 (if different from premises physical location)
Premises Physical Location
Premises Mailing Address

Submission of Lab Results

Applicant Signature

The undersigned hereby applies for a permit to import poultry waste, live poultry or hatching eggs. In signing this form, I certify the responses/entries are true. I am aware if any of the responses/entries are willfully false, I am subject to punishment. I certify that I will comply with all required New Jersey and federal animal health laws, regulations, and directives. I will notify the New Jersey Department of Agriculture of any change in the foregoing information before shipping and changes in shipment origin, information and/or destination require a new permit request.