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National Veterinary Accreditation Program Application Form

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UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
NATIONAL VETERINARY ACCREDITATION PROGRAM
APPLICATION FORM

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0297.

OMB Approved 0579-0297
Exp. 11/2012

7. Name of Veterinarian (Last, First, M, Suffix):

8. Six-Digit National Accreditation Number:

9. Other Names Used (e.g., Maiden Name): 10. Date of Birth: 11. School of Veterinary Medicine: 12. Year Graduated:

13. State where First Orientation Completed: 14. Are you interested in participating in State or Federal agricultural emergency response efforts?

ACCREDITATION CATEGORY SELECTION

select only one – Block 15 OR 16

15. Category I animals (includes canines, felines, amphibians/reptiles, furbearing animals, laboratory animals (rodents), and non-human primates)

Refer to Explanation of Codes Page

Practice Code(s): 3 4 8 9 (select up to two)

Species Code(s): 1 2 12 16 17 18

(select up to four; this does not limit the number of Category I species upon which you may perform accredited duties)

Primary Medical Discipline:

Employment Type:

16. Category II animals (includes all animals)

Refer to Explanation of Codes Page

Practice Code(s): (list up to two)

Species Code(s):

(select up to four; this does not limit the number of species upon which you may perform accredited duties)

Primary Medical Discipline:

Employment Type:

CONTACT INFORMATION

17. Home Mailing Address:

18. City: 19. State: 20. ZIP Code:

21. County of Home Mailing Address:

22. Home Phone:

23. Email Address:

24. Name of Business:

25. Business Mailing Address:

26. City: 27. State: 28. ZIP Code:

29. County of Business Mailing Address:

30. Business Phone:

31. Business FAX Number:

32. Business Cell Phone:

33. Please mark the Contact Information USDA may make available to the public: (select at least one)

ACCREDITATION RENEWAL OR CHANGE OF ACCREDITATION CATEGORY

Complete only if block 3 or block 5 are selected.

Enter the module numbers, not names, of the APHIS approved supplemental training modules you have completed. Category I veterinarians: three modules; Category II veterinarians: six modules.

34. Module Number


 35. Course Type


 36. Date Module Completed








By signing in block 37, I certify that the information contained in this form is true and correct to the best of my knowledge. I am able to perform the tasks listed in Title 9 Code of Federal Regulations (CFR) Part 161.1(g) for the accreditation category designated in Blocks 15 or 16. I have been given a copy of the Standards of Accredited Veterinarian Duties contained in Title 9 CFR Part 161.4, and I agree to conduct all activities as an accredited veterinarian in accordance with the Standards of Accredited Veterinarian Duties.

37. Signature of Veterinarian:

38. Date:

Signature of the Veterinarian-in-Charge and the State Animal Health Official appearing below denotes endorsement of the applicant for veterinary accreditation and/or authorization in a new State. Signatures are NOT required for Accreditation Renewal or Change in Accreditation Category.

39. Signature of State Animal Health Official:

40. Date:

41. Signature of Veterinarian-in-Charge:

42. Date:

PRIVACY ACT NOTICE

General: This information is provided pursuant to Public Law 95-3579 (Privacy Act of 1974) December 31, 1974, for individuals completing the VS 1-36A.

Authority: 5 U.S.C. 3301, 7 U.S.C. 8309, and 21 U.S.C. 113a

Routine Uses: The information will be used for referral to State Animal Health officials, state veterinary examining boards, disclosure to the public for locating accredited veterinarians, referral to appropriate agencies, Department of Justice, courts, agencies responding to a compromise, cooperative government officials, USDA contractors, and records management inspections.

Effects of Nondisclosure: Although this information is voluntary, failure to complete all the information may delay the process of the application or it may result in the application not being processed.

EXPLANATION OF CODES

Species Codes (Blocks 15 & 16) — 1 Canine, 2 Feline, 3 Equine, 4 Bovine, 5 Porcine, 6 Ovine/Caprine, 7 Camelid, 8 Cervid, 9 Poultry, 10 Avian (non-poultry), 11 Exotics, 12 Amphibian/Reptile, 13 Aquatic Animal, 14 Zoo Animal, 15 Wildlife, 16 Furbearing Animals, 17 Laboratory Animal, 18 Non-Human Primate, 19 Human, 20 Other Species, 21 No Species Contact.

Practice Codes (Blocks 15 & 16) — 1 Food Animal Predominant, 2 Food Animal Exclusive, 3 Companion Animal Predominant, 4 Companion Animal Exclusive, 5 Mixed Animal, 6 Equine Predominant, 7 Equine Exclusive, 8 Other, 9 No Species Contact.

Primary Medical Disciplines (Blocks 15 & 16) — Anatomy, Anesthesiology, Animal Behavior, Animal Welfare, Alternative/Contemporary, Association Management, Biochemistry, Biomedical Engineering, Business/Economics, Cardiology, Dentistry, Dermatology, Disaster Medicine, Ecology, Emergency and Critical Care, Endocrinology, Environmental Health, Epidemiology, Ethics, General Medicine, Genetics, Human Animals Bond, Homeland Security, Immunology, Internal Medicine, Insurance, Laboratory Animal Medicine, Law, Media, Microbiology, Mycology/Bacteriology, Molecular Biology, Neurology, Non-Medical, Nutrition, Oncology, Ophthalmology, Parasitology, Pathology - Anatomic, Pathology - Clinical, Pharmacology, Pharmacology - Clinical, Physiology, Population Medicine, Poultry Medicine, Preventative Medicine, Production Medicine, Public Health, Radiology, Shelter Medicine, Sports Medicine, Surgery, Theriogenology, Toxicology, Virology, Wildlife Medicine, Zoological Medicine, Other Professional Discipline.

Employment Type (Blocks 15 & 16) — Private Clinical Practice, Academia, Government, Industry/Commercial, Other. See form for full coded list.

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What the National Veterinary Accreditation Program Application Form Is

The National Veterinary Accreditation Program (NVAP) Application Form is the federal application used to request accreditation to perform regulatory veterinary tasks under USDA Animal and Plant Health Inspection Service programs. The form captures applicant identity, professional credentials, employer and practice details, training records, and attestations required for accreditation classification. Proper completion documents eligibility to participate in animal health surveillance, import/export certification, and other federally authorized activities.

Why Completing the Form Carefully Matters

Accurate NVAP applications protect public animal health, avoid processing delays, and document credentials for regulatory duties. A complete form supports timely accreditation decisions and reduces the chance of requests for additional information.

Why Completing the Form Carefully Matters

Who Typically Completes This Application

The application is completed by veterinarians seeking USDA NVAP accreditation or by authorized representatives submitting on their behalf.

  • State and federal animal health officials verifying practitioner eligibility and credentials.
  • Private practice veterinarians applying for accreditation to perform regulatory tasks.
  • Veterinary college faculty or clinic administrators submitting institutional applicants.

Applications may also be prepared by clinic staff or contracted compliance teams, but the veterinarian named on the form must provide required attestations and signatures.

Step-by-Step: Completing the NVAP Application

Follow these discrete steps to prepare a complete application and minimize follow-up requests.

  • 01
    Gather Documents: Collect license, CE certificates, and employer verification.
  • 02
    Enter Applicant Data: Complete name, license number, address, and contact details.
  • 03
    Attach Training Records: Upload or attach course certificates and dates.
  • 04
    Sign and Submit: Sign the attestation and route to the issuing agency.

Where and How to Submit Your Completed Form

NVAP applications are submitted to the responsible federal or state animal health office depending on program instructions; follow the routing instructions on the form or program guidance.

  • Federal Routing: Submit to USDA APHIS or designated NVAP mailbox per program guidance.
  • State Routing: Some states require submission to or notification of the State Animal Health Official.
  • Supporting Records: Include scanned copies of licenses, CE certificates, and employer letters when requested.
  • Confirmation: Keep proof of submission and any confirmation number received.

Configure an Online Submission Workflow

Set up a digital workflow to collect, validate, and route NVAP applications efficiently.

Field Configuration
Document Upload Require PDF or DOCX; max file size 10 MB
Conditional Logic Show state-specific fields only when applicable
Authentication Email verification or SMS code for signer validation
Notifications Automatic emails to applicant and agency on submission

Digital Submission and Platform Considerations

Choose a platform that supports the file types, authentication, and audit trail needed for regulatory submissions.

  • Supported Formats: PDF and DOCX accepted; preserve embedded metadata
  • Authentication: Email + optional SMS or KBA for higher assurance
  • Integrations: Connectors for cloud storage and agency intake systems

Ensure the chosen system retains an auditable record of signatures, timestamps, and attachments to satisfy federal and state review requirements.

eSignature Vendor Pricing Snapshot for NVAP eSubmission Workflows

Compare basic vendor pricing and core attributes for use in NVAP digital application workflows; detailed plan features and enterprise pricing vary by contract.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day trial Varies Varies Varies Varies
Bulk Send Yes Varies Varies Varies Varies
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Varies Varies Varies Varies
Envelope Cap No cap 100 envelopes/user/year Varies Varies Varies

Essential Data Elements to Include on the Form

Applicant Name: Full legal name
License Details: State and license number
Practice Address: Street, city, state, ZIP
Accreditation Class: Requested category
Training Evidence: Course titles and dates
Contact Info: Phone and valid email

Consequences of Errors or Omissions

Application Rejection: Incomplete forms may be rejected
Processing Delays: Missing attachments extend review time
Accreditation Denial: False or unverifiable claims can lead to denial
Suspension Risk: Post-approval issues may lead to suspension
Civil Penalties: Statutory fines or administrative penalties possible
Professional Impact: Credential or practice restrictions may result

Common Preparation Mistakes to Avoid

  • Using informal or mismatched names across documents, causing identity verification failures and processing delays.
  • Omitting or submitting illegible training certificates; verify course titles and dates match application entries.
  • Failing to attach employer verification or role descriptions when required, which can trigger requests for clarification.
  • Relying on expired professional licenses or failing to disclose state disciplinary actions, risking denial or investigation.

Key Sections of a Professional NVAP Application

A complete application groups personal, professional, training, and attestations into clear sections; each section should be supported by corroborating documents.

Applicant Information

Identifying data and contact information for the veterinarian, including legal name, preferred mailing address, phone, and email.

License & Credentials

State license number, licensing board name, and any specialty certifications required to demonstrate professional standing.

Training Records

Continuing education or NVAP-specific training certificates with dates and provider names to substantiate qualification.

Employer Verification

Letter or form from the employer verifying practice location, duties, and approval for accreditation responsibilities.

Attestations

Signed declarations concerning compliance with federal animal health regulations and commitments to maintain required training.

Submission Checklist

A final checklist documenting included attachments to reduce omissions and speed agency review.

Realistic Application Scenarios

Two illustrative scenarios show typical applicants and how they prepared a compliant submission.

State Animal Health Office

A state-employed veterinarian completed the NVAP form to obtain accreditation for export certification

  • The office attached current state license and employer letter
  • The application included scanned CE certificates, the employer verification, and a clear checklist, resulting in a single agency request for clarification and a timely approval.

Private Clinic Applicant

A private practice veterinarian applied for accreditation to perform regulatory testing

  • The clinic supplied training records and a practice verification letter
  • The signer used an auditable eSignature and retained confirmation of submission, which simplified the agency review and reduced follow-up requests.

Practical Tips for Accurate and Efficient Submission

Adopt a repeatable checklist and digital workflow to minimize errors and speed agency review.

Use Consistent Legal Names
Always match the applicant's legal name to government-issued ID and licensing records to prevent identity verification failures or application rejections.
Verify Document Legibility
Scan certificates at 300 dpi or higher, name files descriptively, and confirm that dates and provider names are clear before attaching to the application.
Keep a Submission Log
Record the submission date, confirmation numbers, and any agency correspondence to support audits and speed responses to inquiries.
Choose Appropriate Authentication
For electronic signatures, prefer platforms that provide a robust audit trail and optional multi-factor authentication when higher assurance is required.

Frequently Asked Questions About the NVAP Application

Answers to common process, signature, and documentation questions for applicants preparing NVAP forms.


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