Form APHIS 81 APHIS 81 Statement of Services

See reverse side for Information Collection Burden Statement

OMB APPROVED
0579-0055
EXP DATE XX/XXXX

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0579-0055. The time required to complete this information collection is
estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.