National Premises ID Application
USDA Animal Disease Traceability Registration
For Bison, Cattle, Goats, Poultry, Sheep, and Swine
Business/Farm Name: _______________________________________________________________________
Primary Contact: ___________________________________________________________________________
Premise Owner’s First Name, Middle Name, and Last Name
Secondary Contact: _________________________________________________________________________
First Name, Middle Name, Last Name, and Phone Number
Business/Farm Mailing Address: ______________________________________________________________
City: ______________________ State: _____________ Zip: _____________ County:____________________
Phone #s: Business ___________________ Home ____________ Cell: ____________ Fax: _______________
Business Type: ☐Individual
☐Partnership ☐Incorporated ☐Limited Liability Corporation
(Check One) ☐Limited Liability Partnership ☐Non-Profit Organization
Operation Type— (Choose All That Apply to the Entire Business)
☐
Production Unit
Farm, Ranch, Flock, Feedlot,
Hunting, Leased Hobby Farm,
etc.
☐
Exhibition
Animal Show or Exhibition
(e.g. State Fair, National
Show, etc.)
☐
Non- Producer
Participant
Records animal info and has no
association with the animals (e.g.
AIN Manager)
☐
Rendering
Location where animals
that died at the farm or
in-transit are processed
☐
Clinic
Location where animals are
examined or treated by a
veterinarian
☐
Laboratory
Location where animals are
terminated and carcasses are
examined
☐
Port of Entry
Location where animals are allowed
to enter into the United States
☐
Slaughter Plant
Location where animals
are terminated for
consumption
☐
Tagging Site
Location where animals are tagged
with an official
USDA-approved ID
device
☐
Market/ Collection
Point
Livestock market/auction or
collection point where
animals are sold
☐
Quarantine Facility
Location where animals are
quarantined.
☐
Other
Please explain:
Premises Information
This is the primary location where the livestock resides. If you have more than one location and animals are managed separately, you may apply for
multiple premises ID numbers.
Premises Name/Description: _______________________________________________________________________
(E.g. home place, heifer place, etc.)
Premises Address: Check this box if it’s the same as the business/farm mailing address above. ☐
Or, if not the same as the business/farm mailing address:
Premises Physical Address: ___________________________________________________________________
City: ______________________ State: _________ Zip: _____________ County: _______________________
Premises Type (Check all that apply): ☐Producer Unit/Farm ☐Clinic ☐Exhibition ☐Laboratory
☐ Market/Collection Point ☐Non-Producer Participant ☐Port of Entry ☐Quarantine Facility ☐Rendering
☐Slaughter Plant ☐Tagging Site
Species at Premises (Check all that apply): ☐Cattle & Bison ☐Swine ☐Sheep ☐Goats ☐Poultry
Email Address:
