Information Collection

Private Sector

IC 2183 under ICR 202003-0579-001 · OMB 0579-0101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0101 can be found here:

2025-02-10 - No material or nonsubstantive change to a currently approved collection
2024-10-10 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VS 5-18 Private Sector	Form
VS 5-18 Record of Animals Moved VS 5-18 Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf	Form
VS 5-19D Scrapie Epidemiology Report VS 5-19D Feb 2011.pdf	Form
VS 5-19 Flock Inspection and Epidemiology Report VS 5-19 DEC 2011.pdf	Form
VS 5-20 Individual Animal Information Report VS 5-20 DEC 2011.pdf	Form
VS 1-23 Appraisal and Indemnity Claim Form VS 1-23 AUG 2018.pdf	Form
VS 1-23A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.pdf	Form
VS 1-24 Proceeds from Animals/Animal Products/Materials Sold for VS 1-24 AUG 2018 (SECURE).pdf	Form
VS 5-19C Scrapie PEMMP Inspection Report VS 5-19C Feb 2011.pdf	Form
VS 5-29 Cooperative State - Scrapie Control Program VS 5-29 DEC 2011.pdf	Form
VS 5-29 A Scrapie Test Record - Continuation Sheet VS 5-29A DEC 2011.pdf	Form
VS 10-4 Specimen Submission VS 10-4 AUG 2009 fillable SECURE.pdf www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Form
VS 5-22 Application for the Scrapie Flock Certification Program VS 5-22 June 2013.pdf www.aphis.usda.gov/library/forms/pdf/vs5_22.pdf	Form
VS 5-18 A Record of Animals Acquired VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18a.pdf	Form
VS 5-19 A Flock Inspection and Epidemnity Report Initial Flock Ins VS 5-19A June 2013 Final.pdf	Form
VS 5-19 b Flock Inspection and Epidemiology Report Flock Inspectio VS 5-19B June 2013 Final.pdf	Form
VS 17-140 United States Origin Health Certificate VS 17-140 AUG 2018.pdf	Form
VS 1-27 Permit for Movement of Restricted Animals VS 1-27 JUL 2011 (OMB).pdf	Form
VS 5-11 SALES AND DISPOSITIONS VS 5-11 Nov 2018.pdf	Form
VS 5-11A SALES AND DISPOSITIONS CONTINUATION SHEET VS 5-11A Nov 2018.pdf	Form
VS 5-12 ADDITIONS - NATURAL/PURCHASED VS 5-12 Nov 2018.pdf	Form
VS 5-12A ADDITIONS - NATURAL/PURCHASED CONTINUATION SHEET VS 5-12A Nov 2018.pdf	Form
VS 5-10 TERMINAL FEEDLOT APPROVAL VS 5-10 NOV 2018).pdf	Form
VS 5-13 OWNER / HAULER STATEMENT FOR SHEEP AND GOATS VS 5-13 NOV 2018.pdf	Form
How to Create an On-Line CVI for AV.ppt How to Create an On-Line CVI for AV	IC Document
Appendix A-1 FY 2010 Scrapie CA Guidance.docx Appendix A-1 FY 2010 Scrapie CA Guidance	IC Document
Appendix A-2 Coop Agreement Award ASI 10-9100-1231.pdf Appendix A-2 Coop Agreement Award ASI 10-9100-1231	IC Document
Appendix A-3 NIAAGrant.pdf Appendix A-3 NIAAGrant	IC Document
Appendix A-4_ MOU template for scrapie.doc Appendix A-4_ MOU template for scrapie	IC Document
Appendix B_10-4 and 5-29 worksheets.docx Appendix B_10-4 and 5-29 worksheets	IC Document
Appendices C-E screenshots.doc Appendices C-E screenshots	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Private Sector

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 9 CFR 54.2 - 54.21, 79.2 - 79.6

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	VS 5-18	Record of Animals Moved	VS 5-18 Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf	Yes	No	Printable Only
Form	VS 5-19D	Scrapie Epidemiology Report	VS 5-19D Feb 2011.pdf		No		Paper Only
Form	VS 5-19	Flock Inspection and Epidemiology Report	VS 5-19 DEC 2011.pdf		No		Paper Only
Form	VS 5-20	Individual Animal Information Report	VS 5-20 DEC 2011.pdf		No		Paper Only
Form	VS 1-23	Appraisal and Indemnity Claim Form	VS 1-23 AUG 2018.pdf		No		Paper Only
Form	VS 1-23A	Indemnity Worksheet - Owner/Company	VS 1-23A-work May 2009.pdf		No		Paper Only
Form	VS 1-24	Proceeds from Animals/Animal Products/Materials Sold for Salvage	VS 1-24 AUG 2018 (SECURE).pdf		No		Paper Only
Form	VS 5-19C	Scrapie PEMMP Inspection Report	VS 5-19C Feb 2011.pdf		No		Paper Only
Form	VS 5-29	Cooperative State - Scrapie Control Program	VS 5-29 DEC 2011.pdf		No		Paper Only
Form	VS 5-29 A	Scrapie Test Record - Continuation Sheet	VS 5-29A DEC 2011.pdf		No		Paper Only
Form	VS 10-4	Specimen Submission	VS 10-4 AUG 2009 fillable SECURE.pdf	http://www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Yes	No	Printable Only
Form	VS 5-22	Application for the Scrapie Flock Certification Program	VS 5-22 June 2013.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_22.pdf	Yes	No	Printable Only
Form	VS 5-18 A	Record of Animals Acquired	VS 5-18A Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_18a.pdf	Yes	No	Printable Only
Form	VS 5-19 A	Flock Inspection and Epidemnity Report Initial Flock Inspection for Complete Monitored Status in SCrapie Flock Certification Program	VS 5-19A June 2013 Final.pdf		No		Paper Only
Form	VS 5-19 b	Flock Inspection and Epidemiology Report Flock Inspection for Complete Monitored Status in the Scrapie Flock Certification Program	VS 5-19B June 2013 Final.pdf		No		Paper Only
Form	VS 17-140	United States Origin Health Certificate	VS 17-140 AUG 2018.pdf		No		Paper Only
Form	VS 5-11	SALES AND DISPOSITIONS	VS 5-11 Nov 2018.pdf		No		Printable Only
Form	VS 5-11A	SALES AND DISPOSITIONS CONTINUATION SHEET	VS 5-11A Nov 2018.pdf		No		Printable Only
Form	VS 5-12	ADDITIONS - NATURAL/PURCHASED	VS 5-12 Nov 2018.pdf		No		Paper Only
Form	VS 5-12A	ADDITIONS - NATURAL/PURCHASED CONTINUATION SHEET	VS 5-12A Nov 2018.pdf		No		Paper Only
Form	VS 1-27	Permit for Movement of Restricted Animals	VS 1-27 JUL 2011 (OMB).pdf		No		Paper Only
Form	VS 5-10	TERMINAL FEEDLOT APPROVAL	VS 5-10 NOV 2018).pdf		No		Paper Only
Form	VS 5-13	OWNER / HAULER STATEMENT FOR SHEEP AND GOATS	VS 5-13 NOV 2018.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records

Title: Animal health Surveillance and Monitoring System

FR Citation: 76 FR 228

Number of Respondents: 155,003

Number of Respondents for Small Entity: 150,350

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 25 %

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	1,730,719	464,381	412,607	853,731
Annual IC Time Burden (Hours)	989,607	64,091	-33,473	958,989
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
How to Create an On-Line CVI for AV	How to Create an On-Line CVI for AV.ppt	11/15/2012
Appendix A-1 FY 2010 Scrapie CA Guidance	Appendix A-1 FY 2010 Scrapie CA Guidance.docx	11/15/2012
Appendix A-2 Coop Agreement Award ASI 10-9100-1231	Appendix A-2 Coop Agreement Award ASI 10-9100-1231.pdf	11/15/2012
Appendix A-3 NIAAGrant	Appendix A-3 NIAAGrant.pdf	11/15/2012
Appendix A-4_ MOU template for scrapie	Appendix A-4_ MOU template for scrapie.doc	11/15/2012
Appendix B_10-4 and 5-29 worksheets	Appendix B_10-4 and 5-29 worksheets.docx	11/15/2012
Appendices C-E screenshots	Appendices C-E screenshots.doc	11/15/2012

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