State

Highly Pathogenic Avian Influenza - Preparedness Questionnaires

Documents and Forms

Document Name Document Type
Fall HPAI Survey_Final.pdf to be determined Other-survey
State Contacts and Resources.xlsx Instruction
National Assembly-Offical State Agency Sample Email.docx Email to States IC Document

Information Collection (IC) Details

IC Title:	State	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 9 CFR 1-199 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			State Contacts and Resources.xlsx		Yes	Yes	Fillable Printable
Other-survey			Fall HPAI Survey_Final.pdf	to be determined	Yes	Yes	Fillable Fileable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 68	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	68	68
Annual IC Time Burden (Hours)	136	136
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email to States	National Assembly-Offical State Agency Sample Email.docx	08/04/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.