VS 21-202 2021 NAHMS Swine Large Enterprise Consent Form

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 0579-0315. The time required to complete this information collection is
estimated to average 10 minutes per response, including the time to review instructions, search existing data
resources, gather the data needed, and complete and review the information collected.
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
NATIONAL ANIMAL HEALTH MONITORING SYSTEM
2150 CENTRE AVE, BLDG B
FORT COLLINS, CO 80526

OMB Approved
0579-0315
EXP: 01/2023

2021 NAHMS Swine Large
Enterprise-Consent Form

For release of information for:_______________________ EPAID: __ __ __ 0 0 0 __ __ __ __ Site Number: __ __
(Producer: Hereafter referred to as YOU)

The USDA’s Animal and Plant Health Inspection Service’s (APHIS) National Animal Health Monitoring System (NAHMS) is
conducting a study of U.S. swine operations. NAHMS studies are voluntary and nonregulatory. This study will take an indepth look at U.S. swine operations and provide new and valuable information regarding animal health and management
practices in the U.S. swine industry. To initiate the study, a sample was selected from the confidential list of operations
maintained by USDA’s National Agricultural Statistics Service (NASS). Your operation was selected for participation and will
represent a number of unselected swine operations.
By signing this Consent Form, you are agreeing to allow USDA–NASS staff to provide the following information to the
State NAHMS Coordinator, who is employed by USDA–APHIS: your name, address, phone number, email address,
total inventory, and operation type (market/breeding/other). Confidentiality of your data is crucially important to us.
No name or contact information will be associated with individual data, and no data will be reported in a way that could
reveal the identity of a participant. Data are presented only in aggregated summaries.
The NAHMS Coordinator will share this information with a Federal or State veterinary medical officer (VMO), who will contact
you to administer a Phase II questionnaire. You will also have the opportunity to obtain free testing for your hogs, including
testing for: fecal (Salmonella, E. coli, Enterococcus, Campylobacter) and oral (Seneca Valley Virus) pathogens. Only the Federal
or State VMOs collecting the data know the identity of study participants.
When you are contacted by a Federal or State VMO and asked to participate in the study, you are free to accept or decline
participation at that time. A copy of the questionnaire that will be administered when you’re visited by the Federal or State
VMO can be found at: www.aphis.usda.gov/nahms. If you have been selected but have not been contacted or if you have
questions regarding the study, please call: (866) 907-8190.
1.

Number of hogs on the site today: ________ head

2.

Site Address: _________________________________________________

3.

Phone #: ________________________________

4.

Email Address: _______________________________________________

5.

Use of swine on site (check all that apply):

6.

Any other notes regarding the site, (e.g. animals located in different state, changes to address or contact information):

Market

Breeding

Other

Signature of Consenting Producer:

Date:

Signature of NASDA/NASS Enumerator:

Date:

VS Form 21-202
June 2021

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