Information Collection

State

IC 218105 under ICR 201805-0579-005 · OMB 0579-0209.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form APHIS 2080 Adverse Event Report State	Form
Form APHIS 2081 Adverse Event Report Follow-up Information State	Form
APHIS 2080 Adverse Event Report APHIS 2080 SEP 2015 (SECURE).pdf	Form
APHIS 2081 Adverse Event Report Follow-up Information APHIS 2081 SEP 2015 (SECURE).pdf	Form

IC Title:

State

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 9 CFR 116.9

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	APHIS 2080	Adverse Event Report	APHIS 2080 SEP 2015 (SECURE).pdf		Yes	Yes	Fillable Fileable
Form	APHIS 2081	Adverse Event Report Follow-up Information	APHIS 2081 SEP 2015 (SECURE).pdf		Yes	Yes	Fillable Fileable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,333

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,333	5,333
Annual IC Time Burden (Hours)	10,666	10,666
Annual IC Cost Burden (Dollars)	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.