which arrived on	     
from	     
	''Confinement" for
     
	''Confinement" until three months of age; then antirabies vaccination to be followed by confinement for 30 days.
	"Confinement" until antirabies vaccination at destination to be followed by ''confinement'' for 30 days.
     
     
     
	State health officer in
	U.S. Quarantine Station
     
     

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLIC HEALTH SERVICE

CENTERS FOR DISEASE CONTROL
ATLANTA, GEORGIA 30333

NOTICE TO OWNERS AND IMPORTERS OF DOGS

(Please print)

POINT OF ENTRY - CITY

DATE (mm/dd/yyy)

OWNER'S NAME

PASSPORT No.

OWNER'S COMPLETE ADDRESS &, TELEPHONE No.

DRIVER'S LICENSE No.

STATE ISSUED

ADDRESS WHERE DOG(S) WILL BE CONFINED

The following dog(s) (number, type, age,and description):

(Kind of conveyance - Name of Ship; Flight No. of plane; Tag No. of Vehicle)

, is/are admitted

to the United States, subject to restrictions of section 71.51 of Public Health Service Foreign Quarantine Regulations checked below:

1.

days, which will complete a 30 day period from the date of the antirabies vaccination

(§ 71.51 (c) (2) (i).)

2.

(§ 71.51 (c) (2) (ii).)

3.

(§ 71.51 (c) (2) (iii).)

	The above restrictions are imposed under section 71.51 Title 42, Code of Federal Regulations, and compliance is necessary before
legal quarantine control of the animal(s) is relinquished.

	''Confinement'' as used above means ''restriction of an animal by the owner or his agent to a building or other enclosure in isolation
from other animals and from persons except for contact necessary for its care, or, if it is allowed out of such enclosure, muzzling the
animal and keeping it on leash.''

NOTICE TO OWNER: 

Criminal penalties may be imposed for violating regulations enacted under 42 USC § 264.  Under 18 U.S.C. §§ 3559 & 3557, individuals may be fined up to $250,000 if a violation of the regulation results in the death of a person, or up to $100,000 if a violation of the regulation does not result in a death.

(Signature of Government Officer)

(Name: Please print or type)

(Title)

Statement to U.S. Government Officer

	I certify that I am the owner, or authorized representative of the owner, of the above listed dog(s). I further certify that I acknowledge
and will comply with the restrictions checked above. Also, I will be responsible for complying with any additional measures that may be
required by health departments or other authority in the State of destination.

Copy sent to:

state of destination

(Signature of Owner or Representative)

(Date - mm/dd/yyyy) 

(See reverse side)

CDC 75.37 (f. 4.421)
OMB # 0920-0134
Expiration date:  x/xx/xxxx

Public reporting burden of this collection of information is estimated to average15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number.  Send comments regarding this burden

 

U.S. QUARANTINE STATIONS AND DIVISION OF QUARANTINE HEADQUARTERS

CDC Anchorage Quarantine Station 
4600 Postmark Drive, Suite NC 206 
Anchorage, Alaska 99502 
Ph: (907) 271-6301 
Fax: (907) 271-6325 
Jurisdiction: All ports in Alaska.

CDC Atlanta Quarantine Station 
Hartsfield-Jackson International Airport 
PO Box 45256 
Atlanta, GA 30320 
Ph: (404) 639-1220 
Fax: (404) 639-1224 
Jurisdiction: All ports in Georgia, Alabama, Arkansas, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee.
 
CDC Boston Quarantine Station 
500 Terminal E  2nd floor 
Logan International Airport 
East Boston, MA 02128 
Ph: (617) 561-5701 
Jurisdiction: All ports in Massachusetts, Maine, New Hampshire, and Rhode Island.

CDC Chicago Quarantine Station 
O'Hare International Airport 
AMF O'Hare, POB 66012 
Chicago, IL 60666-0012 
Ph: (773) 894-2960 
Fax: (773) 894-2970 
Jurisdiction: All ports in Illinois, Indiana, Iowa, Kansas, Missouri, and Wisconsin. Canadian pre-clearance port: Toronto.

CDC Detroit Quarantine Station 
2613 World Gateway Place 
McNamara Terminal, Bldg. 830 
Detroit, MI 48242 
Ph: (734) 955-6197 
Fax: (734) 955-7790 
Jurisdiction: All ports in Michigan, Kentucky and Ohio. 

CDC El Paso Quarantine Station 
Center for Border Health Research 
1100 N. Stanton, Ste 410 
El Paso, TX 79902 
Ph: (915) 577-0970 [ex. 12 or 20] 
24-hour answering service number: 
(915) 543-2829 
Fax: (915) 541-1137 
Jurisdiction: All ports in West Texas and New Mexico, including the U.S.- Mexico border for those two states. 

CDC Honolulu Quarantine Station 
Honolulu International Airport 
300 Rodgers Blvd., #67 
Honolulu, HI 96819-1897 
Ph: (808) 861-8530 
Fax: (808) 861-8532 
Jurisdiction: All ports in Hawaii, Guam, and Pacific Trust Territories. 
. 
CDC Houston Quarantine Station 
George Bush Intercontinental Airport (IAH) 
3870 North Terminal Road 
C/O CBP, International Arrivals 
US Public Health Service, IA2.0833 
Houston, Texas 77032 
Ph: (281) 230-3874 
Jurisdiction: All ports in East Texas (Seaports and Airports) and Oklahoma.

CDC Los Angeles Quarantine Station 
Tom Bradley International Terminal 
380 World Way 
Room 1428 (Southside FIS area) 
Los Angeles, CA 90045 
Ph: (310) 215-2365 
Fax: (310) 215-2285 
Jurisdiction: All ports in Southern California (excluding the US-Mexico border counties),Nevada, and Arizona. Southern California counties include Los Angeles, Orange, San Bernardino, Riverside, Ventura, Santa Barbara, and San Luis Obispo.

CDC Miami Quarantine Station 
Miami International Airport 
PO Box 996488 
Miami, FL 33299-6488 
Ph: (305) 526-2910 
Fax: (305) 526-2798 
Jurisdiction: All ports in Florida. Also, pre-clearance ports in the Bahamas.

CDC Minneapolis Quarantine Station 
Minneapolis-St. Paul International Airport 
Lindberg Terminal 
C/O CBP 
4300 Glumack Drive 
St. Paul, MN 55111-3010 
Ph: (612) 725-3005 
Jurisdiction: All ports in Minnesota, Nebraska, North Dakota and South Dakota.

CDC Newark Quarantine Station 
Newark Liberty International Airport 
Terminal B - Box 52 
Newark, NJ 07114 
Ph: (973) 368-6200 
Fax: (973) 368-6004 
Hours: 9:00 AM-5:30 PM Mon-Fri 
Officer in Charge: John Bateman 
Jurisdiction: All ports in New Jersey and Delaware.

CDC New York Quarantine Station 
JFK International Airport 
Room 219.016 Terminal 4 (E) 
Jamaica, NY 11430-1081 
Ph: (718) 553-1685 
Fax: (718) 553-1524 
Jurisdiction: All ports in New York, Connecticut, Pennsylvania, and Vermont. Canadian pre-clearance port: Montreal. Also, pre-clearance at Shannon and Dublin. 

CDC San Diego Quarantine Station 
3851 Rosecrans St., 
P.O. Box 85524, MS-P511B OBH 
San Diego, CA 92138-5524 
Ph: (619) 692-5659 
Fax: (619) 692-8821 
Jurisdiction: All ports and the U.S.-Mexico border in San Diego, Imperial Counties of Southern California and all U.S.-Mexico border crossings in Arizona, including Tucson Airport.

CDC San Francisco Quarantine Station 
San Francisco International Airport 
PO Box 280548 SFIA 
San Francisco, CA 94128-0548 
Ph: (650) 876-2872 
Fax: (650) 876-2796 
Officer in Charge: Susan Dwyer 
Jurisdiction: All ports in Central and Northern California (46 counties).

CDC San Juan Quarantine Station 
Luis Munoz Marin International Airport 
Terminal D, 3rd floor 
San Juan, PR 00937-0197 
Ph: (787) 774-7812 
Jurisdiction: All ports in Puerto Rico and the U.S. Virgin Islands.

CDC Seattle Quarantine Station 
Seattle-Tacoma International Airport 
Room S-2067 
Seattle, WA 98158-1250 
Ph: (206) 553-4519 
Fax: (206) 553-0855 
Hours: 7:30 AM-3:30 PM, Mon-Fri 
Officer in Charge: Heather Hastings 
Jurisdiction: All ports in Washington, Colorado, Idaho, Montana, Oregon, Utah, and Wyoming. Canadian pre-clearance ports: Edmonton, Calgary, Vancouver, and Victoria

CDC Washington Quarantine Station 
Dulles International Airport 
P.O. Box 17087 
Washington, DC 20041 
Ph: (703) 661-1320 
Jurisdiction: All ports in Washington DC, Maryland, Virginia, and West Virginia.  

For Public Health assistance, contact the appropriate office above.

CDC 75.37 (f. 4.421) (BACK)

REV. 02/2009

. ~ ~ I

I

I