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IED Portal

An Official Pennsylvania Government Website

Pennsylvania Department of Agriculture

PDA

PERMIT APPLICATION TO MOVE – POULTRY, EGGS & OTHER PRODUCTS

Contact Person At Origin Location Of Animals Or Products

First Name

Last Name

Contacts Email

Business Name

Phone

Physical Address of Origin

City

State

Zip Code

Premises ID

Contacts Mailing Address

Contact Person at Destination and Final Location of Animals or Products

First Name

Last Name

Contacts Email

Business Name

Phone

Physical Address of Destination

City

State

Zip Code

Premises ID

Contact’s Mailing Address

There are more than 1 destinations or stops on this route

There are more than 1 destinations or stops on this route NoThere are more than 1 destinations or stops on this route Yes

Product And Movement Information

Permit Area Class

Reason for Movement

Associated Species

Items to Permit

Item Class

Units of Items

Estimated # of units per shipment days

Estimated # of shipment days

Shipments Approx. Start Date

Shipments Approx. End Date

Notes

Collection Date #1

Accession #1

Collection Date #4

Accession #4

Collection Date #2

Accession #2

Collection Date #6

Accession #5

Collection Date #3

Accession #3

Collection Date #5

Accession #6

Owner Certification

REQUIRED:

Attached is the site-specific biosecurity plan patterned from the NPIP Standard E Biosecurity Plan Template for the premises of origin.

Attached are appropriate lab accession reports listed above, if available.

Date

Printed Name

Email

Phone

Address

City

State

Zip Code

Signature - This Space for Official Use Only

Approved

Testing Verified

Disapproved

No Testing Needed

Void

Approved Biosecurity Plan

Plan Submitted By

PENNSYLVANIA APPROVAL - The birds, eggs, or products listed in this shipment are approved for movement.

Date Approved

Permit No

Approving Authority

Comments

Attachment

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