Information Collection

AgDiscovery Application - Individuals or Households

IC 189500 under ICR 202106-0579-010 · OMB 0579-0362.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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 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 %

table that charts list of burden
	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

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.