Nycha 040 505A Form PDF Details

For many pet owners living in New York City Housing Authority (NYCHA) properties, the NYCHA 040.505A form, known as the Dog and Cat Veterinarian Certification, is a critical piece of documentation. Revised in August 2006, this form embodies the NYCHA's commitment to maintaining a safe and healthy environment for all residents by ensuring that dogs and cats residing within their properties are well cared for and meet specific health standards. Upon completing the Dog and Cat Registration form, tenants are required to have their pets examined by a veterinarian who then completes the 040.505A form, verifying the pet's health status. This process includes confirmation of vital details such as the pet's type, breed, date of birth, current and expected weight, and crucial health requirements such as rabies vaccination and spaying or neutering status. The form, which must be submitted to the management office no later than 90 days after being issued, plays a pivotal role in ensuring that pets living in NYCHA housing are not only licensed but also carry a current rabies vaccination tag when in public spaces, adhering to New York City Department of Health and Mental Hygiene regulations. Moreover, the necessity to resubmit this form only arises if a new pet is acquired, although the city's health department mandates regular revaccination. This streamlined process aids in maintaining the health and safety standards that benefit both the pets and the community residing in NYCHA properties.

QuestionAnswer
Form NameNycha 040 505A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescat registration nyc, nycha dog and cat policy, nycha dog registration, pet registration form

Form Preview Example

NYCHA 040.505A (REV. 8/06)

DOG AND CAT VETERINARIAN CERTIFICATION

NEW YORK CITY

HOUSING AUTHORITY

FOR OFFICE USE ONLY

PET TRACKING #

TENANT OF RECORD

STREET ADDRESS

ACCOUNT # (9 digit)

NOTE TO TENANT

After you submit the Dog and Cat Registration form to NYCHA, bring your pet to a veterinarian for examination and ask the veterinarian to complete this form.

You must return the completed form to your management offi ce no later than __________________

(90 days after form is given to tenant).

You will not have to submit a new Veterinarian form again unless you get a new pet. However, you are required by the New York City Department of Health and Mental Hygiene to have your dog or cat revaccinated upon expiration of the vaccination certificate.

PET DESCRIPTION

PET TYPE

DOG

CAT

PET’S DATE OF BIRTH

BREED

 

 

DESCRIPTION (e.g., color, markings)

CURRENT WEIGHT

EXPECTED WEIGHT WHEN FULLY-GROWN

LBS.

LBS.

 

 

 

HEALTH REQUIREMENTS

 

 

 

 

 

 

NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE

 

 

 

DOG LICENSE NUMBER

 

(A dog must be licensed and must wear its license tag when in public)

 

 

 

 

 

 

SPAYED OR NEUTERED

 

 

NO

YES

(Dogs and cats must be spayed or neutered)

RABIES VACCINATION CURRENT

NO

YES – TAG #

 

(Dogs and cats must have a current rabies vaccination)

VETERINARIAN CERTIFICATION

I, the undersigned veterinarian, examined the above described pet and certify that the information given is accurate.

NAME OF VETERINARIAN

PROFESSIONAL LICENSE #

BUSINESS ADDRESS

 

TELEPHONE # (

)

SIGNATURE

 

DATE

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