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The NYCHA 040 505A form plays a crucial role in ensuring the health and safety of pets within the New York City Housing Authority (NYCHA) community. This form serves as a veterinarian certification that confirms a pet's health status and compliance with local regulations. Tenants are required to submit this form after registering their dog or cat with NYCHA, and it must be completed by a licensed veterinarian following a thorough examination of the pet. Key details such as the pet's type, breed, and health requirements are documented, including information about spaying or neutering and rabies vaccination status. Additionally, the form includes a section for the veterinarian to affirm the accuracy of the information provided, along with their professional credentials. Timeliness is essential; tenants must return the completed form to their management office within 90 days of receipt. This process not only helps maintain a safe living environment but also ensures that pet owners are aware of their responsibilities regarding pet health and local regulations. Understanding the significance of the NYCHA 040 505A form is vital for pet owners within the NYCHA community, as it fosters responsible pet ownership and compliance with health standards.
Preview - Nycha 040 505A Form
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 |
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DESCRIPTION (e.g., color, markings)
CURRENT WEIGHT |
EXPECTED WEIGHT WHEN |
LBS.
LBS.
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|
HEALTH REQUIREMENTS |
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NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE |
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DOG LICENSE NUMBER |
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(A dog must be licensed and must wear its license tag when in public) |
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SPAYED OR NEUTERED |
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NO
YES |
(Dogs and cats must be spayed or neutered) |
RABIES VACCINATION CURRENT
NO
YES – TAG # |
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(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 |
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TELEPHONE # ( |
) |
SIGNATURE |
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DATE |
Form Characteristics
| Fact Name | Details |
|---|---|
| Form Purpose | The NYCHA 040 505A form certifies that a pet has been examined by a veterinarian. |
| Submission Deadline | Tenants must return the completed form to their management office within 90 days. |
| Pet Requirements | Dogs and cats must be spayed or neutered and have current rabies vaccinations. |
| Veterinarian Role | A licensed veterinarian must complete and sign the form after examining the pet. |
| Tracking Information | The form includes a pet tracking number for NYCHA’s records. |
| Governing Law | This form is governed by regulations from the New York City Department of Health and Mental Hygiene. |
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