Public Health Information System

Forms and Documents

Document Name	Status
Form 5200-15 Public Health Information System Form	Modified
justificationchangerequest0583-0153 9080-3 2106.docx Justification for No Material/Nonsubstantive Change	2017-01-09
justificationchangerequest0583-0153 9060-6 2106.docx Supplementary Document	2016-12-15
justificationchangerequest0583-0153 for 5200-6.docx Supplementary Document	2016-02-24
justificationchangerequest0583-0153-2.docx Supplementary Document	2015-11-24
justificationchangerequest0583-0153.docx Justification for No Material/Nonsubstantive Change	2015-04-27
ICRPHIS2014_1210.doc Supporting Statement A	2014-12-16
Piatkowski responses 110514.docx Supplementary Document	2014-11-06

IC Document Collections

IC ID	Document Title	Status
196167	Public Health Information System Form	Modified

ICR Details

OMB Control No: 0583-0153	ICR Reference No: 201701-0583-001
Status: Historical Active	Previous ICR Reference No: 201612-0583-001
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: 01/17/2017
	Date Received in OIRA: 01/09/2017
Terms of Clearance:

	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

---

Abstract: FSIS is amending FSIS Form 9080-3 to add a checkbox for fish of the order Siluriformes in box 11 on the form. The addition of fish to the form is exempt from the Paper Work Reduction Act (PRA). The estimated burden for the form will not change. Therefore, the burden will not increase.

---

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

---

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

---

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

---

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

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

---

ICR Summary 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:

---

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

---

Common Form ICR:  No

---

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: 01/09/2017

---