Informed 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-XXXX. 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.		OMB Approved 0579-XXXX EXP: XX/20XX
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	NAHMS Sheep 2024 Study Informed Consent Form
Instructions: Please review this form and indicate your willingness to have the opportunity to participate in Phase II of the NAHMS Sheep 2024 Study in Section H, Item 1 on the study questionnaire. If you have any questions about the Biologics Phase, please call a NAHMS representative at 1-866-907-8190. Your participation is voluntary. You may keep this Informed Consent Form for your records. By consenting, 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. 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. Questionnaire 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 biologic testing for your sheep, including testing for: gastrointestinal (GI) parasites, enteric microbes (Salmonella, E. coli, Enterococcus, Campylobacter), and lameness pathogens (including those causing digital dermatitis and foot rot). 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. Confidentiality: APHIS pledges to keep the survey information you provide confidential and will use it only for statistical purposes. According to the provisions of the Confidential Information Protection and Statistical Efficiency Act of Title V, Subtitle A, Public Law 107-347 (CIPSEA) and other applicable Federal laws, your survey responses will be kept confidential and will not be disclosed in identifiable form. For more information on how we protect your information, please visit: https://www.aphis.usda.gov/animal_health/nahms/general/downloads/NAHMS_CIPSEA.pdf. Your information’s security is vitally important to APHIS. Only authorized APHIS employees or those acting on APHIS’s behalf (NAHMS agents) will have access to your individual record data. By law to be an authorized APHIS employee or NAHMS agent, individuals must complete confidentiality training and a confidentiality form which stipulates the requirements for keeping data confidential and the penalties individuals are subject to if identifiable information is released, including a jail term of up to 5 years, a fine of up to $250,000, or both if they disclose ANY identifiable information about you or your establishment. Please note that information on a producer’s animals revealed from sources unrelated to this study, such as testing and inspection for movement or sale of animals or tracebacks on testing done at slaughter, may cause regulatory action for reasons separate and distinct from this study. Further, data are protected from cybersecurity threats. Under the Cybersecurity Enhancement Act of 2015, your data will be protected by U.S. Department of Homeland Security (DHS) cybersecurity monitoring. In the event of a cybersecurity incident, and pursuant to any required legal processes, information from these sources may be used to help identify and mitigate the incident.

VS Form 21-202 1

January 2024