Private Sector

Scrapie in Sheep and Goats; Interstate Movement Restrictions and Indemnity Program

OMB: 0579-0101

IC ID: 2183

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0101 can be found here:

2024-10-10 - No material or nonsubstantive change to a currently approved collection
2024-07-03 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form VS 5-18 Private Sector Form
VS 5-18 Record of Animals Moved VS 5-18 Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf Form
VS 5-18 Record of Animals Moved VS 5-18 Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf Form
VS 5-19D Scrapie Epidemiology Report VS 5-19D Feb 2011.pdf Form
VS 5-19D Scrapie Epidemiology Report VS 5-19D Feb 2011.pdf Form
VS 5-19 Flock Inspection and Epidemiology Report VS 5-19 DEC 2011.pdf Form
VS 5-19 Flock Inspection and Epidemiology Report VS 5-19 DEC 2011.pdf Form
VS 5-20 Individual Animal Information Report VS 5-20 DEC 2011.pdf Form
VS 5-20 Individual Animal Information Report VS 5-20 DEC 2011.pdf Form
VS 1-23 Appraisal and Indemnity Claim Form VS 1-23 AUG 2018.pdf Form
VS 1-23 Appraisal and Indemnity Claim Form VS 1-23 AUG 2018.pdf Form
VS 1-23A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.pdf Form
VS 1-23A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.pdf Form
VS 1-24 Proceeds from Animals/Animal Products/Materials Sold for VS 1-24 AUG 2018 (SECURE).pdf Form
VS 1-24 Proceeds from Animals/Animal Products/Materials Sold for VS 1-24 AUG 2018 (SECURE).pdf Form
VS 5-19C Scrapie PEMMP Inspection Report VS 5-19C Feb 2011.pdf Form
VS 5-19C Scrapie PEMMP Inspection Report VS 5-19C Feb 2011.pdf Form
VS 5-29 Cooperative State - Scrapie Control Program VS 5-29 DEC 2011.pdf Form
VS 5-29 Cooperative State - Scrapie Control Program VS 5-29 DEC 2011.pdf Form
VS 5-29 A Scrapie Test Record - Continuation Sheet VS 5-29A DEC 2011.pdf Form
VS 5-29 A Scrapie Test Record - Continuation Sheet VS 5-29A DEC 2011.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
VS 10-4 Specimen Submission VS 10-4 FEB 2021 SEC.pdf www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf Form
VS 5-22 Application for the Scrapie Flock Certification Program VS 5-22 June 2013.pdf www.aphis.usda.gov/library/forms/pdf/vs5_22.pdf Form
VS 5-22 Application for the Scrapie Flock Certification Program VS 5-22 June 2013.pdf www.aphis.usda.gov/library/forms/pdf/vs5_22.pdf Form
VS 5-18 A Record of Animals Acquired VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18a.pdf Form
VS 5-18 A Record of Animals Acquired VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18a.pdf Form
VS 5-19 A Flock Inspection and Epidemnity Report Initial Flock Ins VS 5-19A June 2013 Final.pdf Form
VS 5-19 A Flock Inspection and Epidemnity Report Initial Flock Ins VS 5-19A June 2013 Final.pdf Form
VS 5-19 b Flock Inspection and Epidemiology Report Flock Inspectio VS 5-19B June 2013 Final.pdf Form
VS 5-19 b Flock Inspection and Epidemiology Report Flock Inspectio VS 5-19B June 2013 Final.pdf Form
VS 17-140 United States Origin Health Certificate VS 17-140 AUG 2018.pdf Form
VS 17-140 United States Origin Health Certificate VS 17-140 AUG 2018.pdf Form
VS 1-27 Permit for Movement of Restricted Animals VS 1-27 JUL 2011 (OMB).pdf Form
VS 1-27 Permit for Movement of Restricted Animals VS 1-27 JUL 2011 (OMB).pdf Form
VS 5-10 TERMINAL FEEDLOT APPROVAL VS 5-10 NOV 2018).pdf Form
VS 5-10 TERMINAL FEEDLOT APPROVAL VS 5-10 NOV 2018).pdf Form
VS 5-13 OWNER / HAULER STATEMENT FOR SHEEP AND GOATS VS 5-13 NOV 2018.pdf Form
VS 5-13 OWNER / HAULER STATEMENT FOR SHEEP AND GOATS VS 5-13 NOV 2018.pdf Form
VS 10-4A Continuation Sheet for Specimen Submission VS 10-4A AUG 2009 (20200629) Secure.pdf Form
VS 10-4A Continuation Sheet for Specimen Submission VS 10-4A AUG 2009 (20200629) Secure.pdf Form
VS 5-13 Owner/Hauler Statement for Sheep and Goats VS 5-13 NOV 2018.pdf Form
VS 5-13 Owner/Hauler Statement for Sheep and Goats VS 5-13 NOV 2018.pdf Form
FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf Grant and Coop Agreement Guide IC Document
FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf Grant and Coop Agreement Guide IC Document
MOU template.docx MOU Template IC Document
MOU template.docx MOU Template IC Document
On-farm_worksheet.pdf On-Farm Worksheet IC Document
On-farm_worksheet.pdf On-Farm Worksheet IC Document
VSLS Goat RSSS_Collection_worksheet_Circle choice.pdf VSLS Goat RSSS Collection Worksheet Circle IC Document
VSLS Goat RSSS_Collection_worksheet_Circle choice.pdf VSLS Goat RSSS Collection Worksheet Circle IC Document
VSLS Goat RSSS_Collection_worksheet_Fill in.pdf VSLS Goat RSSS Collection Worksheet Fill-in IC Document
VSLS Goat RSSS_Collection_worksheet_Fill in.pdf VSLS Goat RSSS Collection Worksheet Fill-in IC Document
VSLS Sheep RSSS_Collection_worksheet_Circle choice.pdf VSLS Sheep RSSS Collection Worksheet Circle IC Document
VSLS Sheep RSSS_Collection_worksheet_Circle choice.pdf VSLS Sheep RSSS Collection Worksheet Circle IC Document
VSLS sheep RSSS_Collection_worksheet_Fill in.pdf VSLS Sheep RSSS Collection Worksheet Fill-in IC Document
VSLS sheep RSSS_Collection_worksheet_Fill in.pdf VSLS Sheep RSSS Collection Worksheet Fill-in IC Document
Appendix C-E Screen Shots SCS-SCR VSLS AIMS_Redacted.pdf Appdx C thru E VSLS AIMS Screenshots IC Document
Appendix C-E Screen Shots SCS-SCR VSLS AIMS_Redacted.pdf Appdx C thru E VSLS AIMS Screenshots IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Private Sector	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 54.2 - 54.21, 79.2 - 79.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VS 5-18	Record of Animals Moved	VS 5-18 Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf	Yes	No	Printable Only
Form	VS 5-19D	Scrapie Epidemiology Report	VS 5-19D Feb 2011.pdf		No		Paper Only
Form	VS 5-19	Flock Inspection and Epidemiology Report	VS 5-19 DEC 2011.pdf		No		Paper Only
Form	VS 5-20	Individual Animal Information Report	VS 5-20 DEC 2011.pdf		No		Paper Only
Form	VS 1-23	Appraisal and Indemnity Claim Form	VS 1-23 AUG 2018.pdf		No		Paper Only
Form	VS 1-23A	Indemnity Worksheet - Owner/Company	VS 1-23A-work May 2009.pdf		No		Paper Only
Form	VS 1-24	Proceeds from Animals/Animal Products/Materials Sold for Salvage	VS 1-24 AUG 2018 (SECURE).pdf		No		Paper Only
Form	VS 5-19C	Scrapie PEMMP Inspection Report	VS 5-19C Feb 2011.pdf		No		Paper Only
Form	VS 5-29	Cooperative State - Scrapie Control Program	VS 5-29 DEC 2011.pdf		No		Paper Only
Form	VS 5-29 A	Scrapie Test Record - Continuation Sheet	VS 5-29A DEC 2011.pdf		No		Paper Only
Form	VS 10-4	Specimen Submission	VS 10-4 FEB 2021 SEC.pdf	http://www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Yes	No	Printable Only
Form	VS 5-22	Application for the Scrapie Flock Certification Program	VS 5-22 June 2013.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_22.pdf	Yes	No	Printable Only
Form	VS 5-18 A	Record of Animals Acquired	VS 5-18A Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_18a.pdf	Yes	No	Printable Only
Form	VS 5-19 A	Flock Inspection and Epidemnity Report Initial Flock Inspection for Complete Monitored Status in SCrapie Flock Certification Program	VS 5-19A June 2013 Final.pdf		No		Paper Only
Form	VS 5-19 b	Flock Inspection and Epidemiology Report Flock Inspection for Complete Monitored Status in the Scrapie Flock Certification Program	VS 5-19B June 2013 Final.pdf		No		Paper Only
Form	VS 17-140	United States Origin Health Certificate	VS 17-140 AUG 2018.pdf		No		Paper Only
Form	VS 1-27	Permit for Movement of Restricted Animals	VS 1-27 JUL 2011 (OMB).pdf		No		Paper Only
Form	VS 5-10	TERMINAL FEEDLOT APPROVAL	VS 5-10 NOV 2018).pdf		No		Paper Only
Form	VS 5-13	OWNER / HAULER STATEMENT FOR SHEEP AND GOATS	VS 5-13 NOV 2018.pdf		No		Paper Only
Form	VS 10-4A	Continuation Sheet for Specimen Submission	VS 10-4A AUG 2009 (20200629) Secure.pdf		Yes	No	Fillable Printable
Form	VS 5-13	Owner/Hauler Statement for Sheep and Goats	VS 5-13 NOV 2018.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title: Animal health Surveillance and Monitoring System	FR Citation: 76 FR 228

Number of Respondents: 174,783	Number of Respondents for Small Entity: 169,540

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,063,788	-667,367	436	1,730,719
Annual IC Time Burden (Hours)	810,927	-111,823	-66,857	989,607
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Grant and Coop Agreement Guide	FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf	10/10/2023
MOU Template	MOU template.docx	10/10/2023
On-Farm Worksheet	On-farm_worksheet.pdf	10/10/2023
VSLS Goat RSSS Collection Worksheet Circle	VSLS Goat RSSS_Collection_worksheet_Circle choice.pdf	10/10/2023
VSLS Goat RSSS Collection Worksheet Fill-in	VSLS Goat RSSS_Collection_worksheet_Fill in.pdf	10/10/2023
VSLS Sheep RSSS Collection Worksheet Circle	VSLS Sheep RSSS_Collection_worksheet_Circle choice.pdf	10/10/2023
VSLS Sheep RSSS Collection Worksheet Fill-in	VSLS sheep RSSS_Collection_worksheet_Fill in.pdf	10/10/2023
Appdx C thru E VSLS AIMS Screenshots	Appendix C-E Screen Shots SCS-SCR VSLS AIMS_Redacted.pdf	10/10/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.