Public Health Information System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5200-2 Application for Federal Inspection	Form and Instruction	Modified	Available
Form FSIS 9010-1 Application for the Return of Exported Products to the United States	Form and Instruction	Modified	Available
Form 9060-6 Application for Export Certificate	Form	Modified	Available
Form 9080-3 Establishment Application for Export	Form and Instruction	Modified	Available
Form 9080-4 Meat, Poultry, and Egg Product List	Form	Modified	Available
Form 5200-15 Hours of Operations	Form	Modified	Available
Form 5200-6 Application/Approval for Voluntary Inspection	Form	Modified	Available
justificationchangerequest0583-0153.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-04-27	Available
walter piatkowski comment FSIS-2014-0025-0002.html	Public Comments	Uploaded 2014-09-16	Repair queued
ICRPHIS2014_1210.doc	Supporting Statement A	Uploaded 2014-12-16	Available
Piatkowski responses 110514.docx	Supplementary Document	Uploaded 2014-11-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
196167	Public Health Information System	Form and Instruction	Modified	Application for Federal Inspection
196167	Public Health Information System	Form and Instruction	Modified	Application for the Return of Exported Products to the United States
196167	Public Health Information System	Form	Modified	Application for Export Certificate
196167	Public Health Information System	Form and Instruction	Modified	Establishment Application for Export
196167	Public Health Information System	Form	Modified	Meat, Poultry, and Egg Product List
196167	Public Health Information System	Form	Modified	Hours of Operations
196167	Public Health Information System	Form	Modified	Application/Approval for Voluntary Inspection
196167	Public Health Information System	Other-screens-Transfer Certificate	Modified

ICR Details

OMB Control No: 0583-0153	ICR Reference No: 201504-0583-001
Status: Historical Active	Previous ICR Reference No: 201410-0583-001
Agency/Subagency: USDA/FSIS	Agency Tracking No:
Title: Public Health Information System
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/04/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/27/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2018	01/31/2018	01/31/2018
Responses	865,480	0	865,480
Time Burden (Hours)	145,481	0	145,481
Cost Burden (Dollars)	0	0	0

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Abstract: FSIS is amending FSIS Form 5200-2. There is no change in the estimated burden.

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Authorizing Statute(s): US Code: 21 USC 451, et seq. Name of Law: Poultry Products Inspection Act
   US Code: 21 USC 601, et seq. Name of Law: Federal Meat Inspection Act
   US Code: 21 USC 1031, et seq. Name of Law: Egg Products Inspection Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 51945	09/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 74682	12/16/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Public Health Information System	FSIS 9010-1, 5200-6, 5200-15, 9080-4, 9080-3, 9060-6, 5200-2	Application/Approval for Voluntary Inspection ,   Hours of Operations ,   Meat, Poultry, and Egg Product List ,   Establishment Application for Export ,   Application for Export Certificate ,   Application for the Return of Exported Products to the United States ,   Application for Federal Inspection

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	865,480	865,480	0	0	0	0
Annual Time Burden (Hours)	145,481	145,481	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $570,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/27/2015

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