State

Conditions for Payment of Highly Pathogenic Avian Influenza Indemnity Claims

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0440 can be found here:

Documents and Forms

Document Name Document Type
Form VS 9-12 State Form
VS 9-12 Grower Contract Worksheets - Layers VS 9-12 JAN 2016.pdf Form
VS 9-12A Grower Contract Worksheets - Layers (Continuation Sheet) VS 9-12a JAN 2016.pdf Form

Information Collection (IC) Details

IC Title:	State	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 9 CFR 53.10

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VS 9-12	Grower Contract Worksheets - Layers	VS 9-12 JAN 2016.pdf		No		Paper Only
Form	VS 9-12A	Grower Contract Worksheets - Layers (Continuation Sheet)	VS 9-12a JAN 2016.pdf		No		Paper Only

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,930	6,930
Annual IC Time Burden (Hours)	694	694
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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