Information Collection

U.S. Origin Health Certificate

IC 2093 under ICR 201707-0579-003 · OMB 0579-0020.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0020 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VS 17-140 U.S. Origin Health Certificate	Form and Instruction
VS 17-140 United States Origin Health Certificate VS 17-140 (NOV 2014).pdf	Form and Instruction
VS Form 17-104A Continuation Sheet for United States Origin Health Certi VS 17-140A (JAN 2011).pdf	Form
VS Form 17-140B Continuation Sheet for U.S. Origin Health Certificate VS 17-140B (JAN 2011).pdf	Form
VS Form 17-145 United States Origin Health Certificate for the Export o VS 17-145 (DEC 2016).pdf	Form
APHIS Form 7001 United States Interstate and International Certificate o APHIS 7001 (NOV 2010).pdf	Form
VS 17-141 Health Certificate for the Export of Live Finfish, Mollu VS 17-141 (MAR 2006).pdf	Form and Instruction

IC Title:

U.S. Origin Health Certificate

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 9 CFR 91

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VS 17-140	United States Origin Health Certificate	VS 17-140 (NOV 2014).pdf	Yes	No	Printable Only
Form	VS Form 17-104A	Continuation Sheet for United States Origin Health Certificate	VS 17-140A (JAN 2011).pdf	Yes	No	Printable Only
Form	VS Form 17-140B	Continuation Sheet for U.S. Origin Health Certificate	VS 17-140B (JAN 2011).pdf	Yes	No	Printable Only
Form	VS Form 17-145	United States Origin Health Certificate for the Export of Horses from the U.S. to Canada	VS 17-145 (DEC 2016).pdf	Yes	No	Fillable Printable
Form	APHIS Form 7001	United States Interstate and International Certificate of Health Examination for Small Animals	APHIS 7001 (NOV 2010).pdf	Yes	No	Fillable Printable
Form and Instruction	VS 17-141	Health Certificate for the Export of Live Finfish, Mollusks, and Crustaceans (and Their Gametes)	VS 17-141 (MAR 2006).pdf	Yes	No	Fillable Printable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,226

Number of Respondents for Small Entity: 1,892

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	35,761	-41,368	4,374	72,755
Annual IC Time Burden (Hours)	17,170	-2,631	2,190	17,611
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
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.