NWS Livestock Permit

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DEPARTMENT OF AGRICULTURE - DIVISION OF ANIMAL HEALTH

NWS Permit Request Form

Pursuant to N.J.S.A. 4:1-21.5, the New Jersey Department of Agriculture (NJDA) is authorized to institute and enforce such measures it deems necessary to control infectious or contagious diseases of livestock and poultry. Per N.J.A.C. 2:2-1.1 NWS is recognized as a “particular and dangerous menace to animal health in the State.” All livestock animals originating in or transiting through a US state that contains an infested zone or adjacent surveillance zone must obtain permitted approval prior to movement, via a permit number from the New Jersey Department of Agriculture - Division of Animal Health. For questions, please reach out to the Division of Animal Health by telephone at (609) 671-6400, by fax at (609) 671-6413, or by email at state.veterinarian@ag.nj.gov (non-holiday weekdays, 8:45 am to 4:30 pm., EST).

Please note a separate permit will be required for each of the following situations:

Only one origin location per permit
Only one species type per permit
Only one destination per permit.

If you have more than one of any of the above situations please fill out an additional permit.

Additional information required. Please follow the instructions below:

Origin Information

Owner First Name

Owner Last Name

Owner Phone Number

Please submit more than one permit request if transporting from more than one origin.

Origin Premises Address - Lookup

Street Address

Unit/Apt

City

State (ex. NJ, CA, DC, etc.)

Zip

County

To identify affected counties, use the USDA NWS dashboard Confirmed Detections of New World Screwworm | APHIS

Origin Zone

Not in Zone

Infested Zone

Adjacent Infested Zone

Veterinarian Information

Veterinarian First Name

Veterinarian Last Name

Veterinarian Address - Lookup

Street Address

Unit/Apt

City

State (ex. NJ, CA, DC, etc.)

Zip

County

Animal Information

Please submit more than one permit request if transporting more than one type of species.

Animal Type (Species) Value is not selected

Other - Please specify

Number of Animals

Animal Name(s) If unnamed, please enter "N/A"

Animal ID (Official ID)

Validation for # of Animals Entered

Livestock, originating in or transiting through an infested zone (but not areas outside of the infested zone in a state) shall be treated by an accredited veterinarian with a systemic product. If you have questions, please call the NJDA DAH 609-671-6400.

Does transport to NJ require a route that transits through an infested zone?

Yes

No

Has NWS treatment been applied?

Yes

No

Date Treatment Applied

What product was applied?

If yes, has the name of the product, date of application, and route of administration been noted on the CVI?

Yes

No

The name of the product used, and the date and route of administration shall be noted on the CVI. If you have questions, please call the NJDA DAH 609-671-6400.

Date of NWS inspection prior to movement

Livestock originating in a US state or transiting through a US State that contains an infested zone or adjacent surveillance zone, shall be accompanied by a Certificate of Veterinary Inspection (CVI) issued by an accredited veterinarian within 5 days prior to entry into New Jersey with a statement indicating freedom from infestation. If you have questions, please call the NJDA DAH 609-671-6400.

Will the CVI be completed within 5 days prior to movement?

Yes

No

Please note the response you provided to the above question will likely result in a denied permit request. If you believe there is a reason your permit would still be approved please include your explanation in the additional information field lower on the form. If you have questions, please call the NJDA DAH at 609-671-640,0.

Destination Information

Please submit more than one permit request if transporting to more than one destination.

Destination Contact First Name

Destination Contact Last Name

Destination Contact Phone Number

Destination Farm Name If unnamed, please enter "N/A"

Destination Address

Street Address

Unit/Apt

City

State (ex. NJ, CA, DC, etc.)

Zip

County

Expected date of arrival in New Jersey

Please provide any additional information or context that may be needed here:

Certification/Signer Information

The undersigned hereby applies for a permit to livestock from an NWS-affected area. 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 transportation of livestock. I
acknowledge changes in animal origin, information and/or destination require a new permit request.

Submitted Internally

Date of Permit Request

Requestor Role Value is not selected

Applicant Signature

Requestor Name

Please enter an active email address. Your permit status and details will be delivered to this email.

Requestor Email

DAH Staff Name

DAH Staff Email

Combined Fields for Dashboard Views/Tagging

Owner Full Name

Owner Address Concat

Vet Full Name

Vet Address Concat

Destination Full Name

Destination Address Concat

Species

Product and Date

Validation Fields

Count Veteranarians

Count Animals

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Animal Health - NWS Livestock Permit

Origin Information

Veterinarian Information

Animal Information

Destination Information

Certification/Signer Information

Combined Fields for Dashboard Views/Tagging

Validation Fields