Public Health Information System

OMB: 0583-0153

IC ID: 196167

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0583-0153 can be found here:

Documents and Forms

Document Name Document Type
Form 5200-6 Public Health Information System Form
Transfer certificate with OMB.docx Other-screens-Transfer Certificate
9080-4 product list screen shots OMB statement March 1 2011.docx Other-screens-Product List
PHIS Sscreen shots 9010-1 030211.pdf Other-screens-Application for Return
9010-1 Application for Return of Exported Goods.pdf Other-screen shots
9080-3 Establishment Application for Export.pdf Other-screen shots
9060-6 Application for Export of Goods In Lieu of Consolidated Split.pdf Other-screen shots
9060-6 Application for Export of Goods.pdf Other-screen shots
5200-6 Application/Approval for Voluntary Inspection FSIS 5200-6.pdf Form
5200-15 Hours of Operations FSIS 5200-15 Hours of Operation Request Approval .pdf Form
9080-4 Meat, Poultry, and Egg Product List FSIS 9080-4.pdf Form
9080-3 Establishment Application for Export FSIS 9080-3 ESTABLISHMENT APPLICATION FOR EXPORT OF _v8508.pdf Form and Instruction
9060-6 Application for Export Certificate FSIS 9060-6 .pdf Form
FSIS 9010-1 Application for the Return of Exported Products to the U FSIS 9010-1 Application for the Return of Exported Products to the United States_v8RE508.pdf Form and Instruction
FSIS Form 5200-2 Application for Federal Inspection FSIS FORM 5200-2 - APPLICATION FOR FEDERAL INSPECTION _v8RE508 (11-18-2015).pdf Form and Instruction
Summary of the changes from the current FSIS Form 5200.docx summary of changes to FSIS Form 5200-2 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Health Information System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	5200-6	Application/Approval for Voluntary Inspection	FSIS 5200-6.pdf	Yes	Yes	Fillable Fileable
Form	5200-15	Hours of Operations	FSIS 5200-15 Hours of Operation Request Approval .pdf	Yes	Yes	Fillable Fileable
Other-screens-Transfer Certificate			Transfer certificate with OMB.docx	Yes	Yes	Fillable Fileable
Form	9080-4	Meat, Poultry, and Egg Product List	FSIS 9080-4.pdf	Yes	No	Fillable Printable
Other-screens-Product List			9080-4 product list screen shots OMB statement March 1 2011.docx	Yes	Yes	Fillable Fileable
Form and Instruction	9080-3	Establishment Application for Export	FSIS 9080-3 ESTABLISHMENT APPLICATION FOR EXPORT OF _v8508.pdf	Yes	No	Fillable Printable
Form	9060-6	Application for Export Certificate	FSIS 9060-6 .pdf	Yes	No	Fillable Printable
Other-screens-Application for Return of Exported Product			PHIS Sscreen shots 9010-1 030211.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FSIS 9010-1	Application for the Return of Exported Products to the United States	FSIS 9010-1 Application for the Return of Exported Products to the United States_v8RE508.pdf	Yes	No	Fillable Printable
Other-screen shots			9010-1 Application for Return of Exported Goods.pdf	Yes	Yes	Fillable Fileable
Other-screen shots			9080-3 Establishment Application for Export.pdf	Yes	Yes	Fillable Fileable
Other-screen shots			9060-6 Application for Export of Goods In Lieu of Consolidated Split.pdf	Yes	Yes	Fillable Fileable
Other-screen shots			9060-6 Application for Export of Goods.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FSIS Form 5200-2	Application for Federal Inspection	FSIS FORM 5200-2 - APPLICATION FOR FEDERAL INSPECTION _v8RE508 (11-18-2015).pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,067	Number of Respondents for Small Entity: 2,750

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	865,480	865,480
Annual IC Time Burden (Hours)	145,481	145,481
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
summary of changes to FSIS Form 5200-2	Summary of the changes from the current FSIS Form 5200.docx	04/23/2015

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