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HIGHLY PATHOGENIC AVIAN INFLUENZA RECOVERY REIMBURSEMENT GRANT ROUND FIVE PLEASE PRINT OR TYPE IN BLUE OR BLACK INK ONLY READ INSTRUCTIONS ON REVERSE SIDE 1. Applicants Name: 2. Payee(s)s Name: PLEASE COMPLETE ONLY ONE: A or B A.Applying under Business/Farm Name BUSINESS EIN#B.ORApplying as individual(s) All individuals whose name appears on the Farm Name, along with their social security number (SS#)Payee 1:Payee 2:SS #SS#Payee 3:Payee 4:SS#SS#3. Owner(s): 4. Business/Farm Name: 5
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How to fill out highly pathogenic avian influenza

01
Obtain the official form for reporting highly pathogenic avian influenza (HPAI) from your local agricultural or wildlife authority.
02
Fill in the date and your contact information at the top of the form.
03
Specify the location where the birds are being kept, including property address and GPS coordinates if available.
04
Indicate the number and species of birds affected by HPAI.
05
Describe the symptoms observed in the birds, such as lethargy, coughing, or decreased egg production.
06
Attach any relevant laboratory test results confirming the presence of HPAI.
07
Provide information on biosecurity measures currently in place at your facility.
08
Sign and date the form before submitting it to the designated authority.

Who needs highly pathogenic avian influenza?

01
Poultry farmers who manage flocks of birds to identify and report outbreaks.
02
Veterinarians who need to diagnose and treat affected birds.
03
Wildlife agencies that monitor avian populations for outbreaks in the wild.
04
Public health officials to prevent the spread of HPAI to humans.
05
Researchers studying the impact of HPAI on animal health and transmission.
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Highly pathogenic avian influenza (HPAI) is a severe form of bird flu caused by influenza A viruses that can lead to high mortality rates in poultry and can also infect humans and other animals.
Poultry producers, veterinarians, and laboratory personnel who suspect or confirm cases of HPAI are required to report it to appropriate authorities to manage outbreaks.
Filling out HPAI reporting forms typically involves providing details such as the type of poultry affected, the number of birds, symptoms observed, and any laboratory test results. Specific guidelines may vary by jurisdiction.
The purpose of monitoring and reporting HPAI is to control and prevent its spread, protect public and animal health, and ensure food safety.
The information that must be reported includes the species of birds, the number of infected or dead birds, locations of the outbreak, dates of onset, and any vaccinations or biosecurity measures taken.
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