Information Collection

State

IC 217643 under ICR 201507-0579-003 · OMB 0579-0436.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fall HPAI Survey_Final.pdf	Other-survey
State Contacts and Resources.xlsx	Instruction
National Assembly-Offical State Agency Sample Email.docx Email to States	IC Document

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey				to be determined	Yes	Yes	Fillable Fileable
Instruction					Yes	Yes	Fillable Printable

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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Email to States		08/04/2015

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

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