AgDiscovery Application - Individuals or Households

APHIS Student Outreach Program

Documents and Forms

Document Name Document Type
Form APHIS FORM 119 AgDiscovery Application - Individuals or Households Form and Instruction
APHIS FORM 119 AgDiscovery Application APHIS 119 - agdiscovery-application.pdf www.aphis.usda.gov/civil_rights/agdiscovery/agdiscovery-application.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	AgDiscovery Application - Individuals or Households	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	APHIS FORM 119	AgDiscovery Application	APHIS 119 - agdiscovery-application.pdf	https://www.aphis.usda.gov/civil_rights/agdiscovery/agdiscovery-application.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	6,000	6,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.