Information Collection

Public Health Information System

IC 196167 under ICR 201711-0583-002 · OMB 0583-0153.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5200-15 Public Health Information System	Form
Transfer certificate with OMB.docx	Other-screens-Transfer Certificate
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
5200-15 Hours of Operations FSIS 5200-15 Hours of Operation Request Approval .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
5200-6 Application/Approval for Voluntary Inspection FSIS 5200-6 Application_Approval for Voluntary Reimbursable Inspection Service_v8508 2_17_11.pdf	Form
FSIS 9060-6 Application for Export Certificate FSIS 9060-6 Application for Export Certificate 07062017.pdf	Form and Instruction
FSIS 9080-3 Establishment Application for Export FSIS 9080-3 Establishment Application for Export 07062017.pdf	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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
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
Form	5200-6	Application/Approval for Voluntary Inspection	FSIS 5200-6 Application_Approval for Voluntary Reimbursable Inspection Service_v8508 2_17_11.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	FSIS 9060-6	Application for Export Certificate	FSIS 9060-6 Application for Export Certificate 07062017.pdf	Yes	No	Fillable Printable
Form and Instruction	FSIS 9080-3	Establishment Application for Export	FSIS 9080-3 Establishment Application for Export 07062017.pdf	Yes	No	Fillable Printable

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: 6,242

Number of Respondents for Small Entity: 519

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	613,480	-252,000	865,480
Annual IC Time Burden (Hours)	103,814	-41,667	145,481
Annual IC Cost Burden (Dollars)	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.