Animal Transfers to the University of Iowa (Form 1 of 2)

University of Iowa

Animal Transfer Questionnaire

Animal Transfers TO the University of Iowa (Form 1 of 2)

UNIVERSITY OF IOWA RECEIVING FORM

Information provided by the University of Iowa Investigator receiving animals from another Institution/Investigator

Date:
UI Investigator Name:
UI Investigator Hawk ID:
UI Protocol Account #:
UI investigator e-mail:
UI Protocol #:
UI Contact person’s name:
UI Contact person e-mail:
UI Contact person phone #:
UI Contact person Emergency Phone #:
Are you a new investigator relocating your colony to the University of Iowa?
NO YES
If you check “Yes” please select a Barrier facility from those listed below.
Housing requested1
Non-Barrier Facilities
Biology
Psychology
BSB
ML
Barrier Facilities
MERF (CBRB)
MTF (Non-investigator access facility)
What is the species/strain?
What strain name should be used on the cage card?
Quantity to be shipped:
Will these animals be used for breeding? / NO
YES
Do you need to breed animals during quarantine? / NO
YES
Provide breeding instructions:2
Will genetic material be required (tail snips)? / NO
YES
Provide instructions concerning genetic material:3
Contact for genetic material notifications:
(if different from above) / Name:
Phone #:
Immune status: / Immunocompetent
Immunocompromised
Will the investigator at the U of Iowa be paying for the shipping? / NO
YES
If shipment requires a temperature controlled carrier (more expensive), do you want to be notified of the additional cost?4
(i.e. incoming shipment and sentinel shipment)
NO
YES
Name of originating institution :
City, State:
Name of Investigator at originating institution:

1Please review the health status of the rodents housed in each facility; conventional facilities may have endemicinfections.

2Animals will be quarantined and Animal Resources personnel will perform breeding during the quarantine period. Please provide breeding instructions (even if breeding will be performed by Investigator personnel after quarantine).

3What material do you want collected and at what age (e.g. tail tips from all mice at weaning age)?

4Consistent with NIH Animal Transportation Guidelines, temperatures below 45° F or above 85°F may jeopardize the welfare of the animals and are to be avoided. If the University of Iowa is paying for the shipment, a temperature-controlled courier may be requested. Also, after quarantine (at the University of Iowa) the sentinel animals must be shipped out for testing. Shipment of the sentinels will require a temperature controlled courier if the above temperature extremes apply. (Ex. For a sentinel shipment to the University of Missouri, regular courier price is approximately $160; temperature controlled courier is approximately $700 [rates are subject to change]).