Information Collection

State, Tribal, Local Government

IC 199210 under ICR 202107-0579-003 · OMB 0579-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0189 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VS 11-2 State, Tribal, Local Government	Form
VS 11-2 Application for Chronic Wasting Disease Herd Certifcatio VS 11-2 AUG 2012 SECURE.pdf www.aphis.usda.gov/library/forms/pdf/VS11_2.pdf	Form
VS 10-4 Specimen Submission VS 10-4 FEB 2021 SEC.pdf www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Form

IC Title:

State, Tribal, Local Government

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 81.2 - 81.4 9 CFR 55.1 - 55.25

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 11-2	Application for Chronic Wasting Disease Herd Certifcation Program (CWD HCP) Approval, Renewal, or Reinstatement of a State	VS 11-2 AUG 2012 SECURE.pdf	http://www.aphis.usda.gov/library/forms/pdf/VS11_2.pdf	Yes	No	Fillable Printable
Form	VS 10-4	Specimen Submission	VS 10-4 FEB 2021 SEC.pdf	https://www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Yes	No	Fillable Printable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 29

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,205	190	-30,835	60,850
Annual IC Time Burden (Hours)	71,525	1,508	-24,110	94,127
Annual IC Cost Burden (Dollars)	0	0	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.