Private Sector

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 15-45 minutes hours per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved
0579-XXXX
Exp. XX/XXXX

HPAI Response

HPAI Affected Dairy Premises Support Agreement
May 29, 2024

Note: This is an agreement for positive HPAI dairy premises to receive USDA financial support for up to 120 days.
Premises Information
Premises ID #
Special ID #
Premises owner
Name of premises
Address of premises
Contact person (for premises)
Contact phone number
Contact e-mail address
Business Owner (if different from premises owner)
Name of authorized representative, if applicable
Address of business owner
Bovines present on premises (include number, sex, age, stage of lactation, if applicable)

PRODUCER (OWNER/OPERATOR):
Signature:

(ink signature required)

Date:

☐VS INCIDENT COMMANDER, DEPUTY IC OR ☐VS DISTRICT DIRECTOR/AREA VETERINARIAN IN CHARGE
Signature:

Date:

☐STATE INCIDENT COMMANDER OR ☐STATE VETERINARIAN:
Signature:

Date:

This is a written agreement developed between USDA APHIS Veterinary Services (VS) and
(Insert Producer (owner/operator); hereafter, “the Producer”). This herd will be
handled in accordance with any additional
(Insert name of State)
regulations/requirements.

This agreement allows the premises to receive financial support from USDA APHIS in response to the HPAI H5N1
event in dairy cattle.
By signing this document, the Producer is indicating a willingness to participate in available support options as
outlined below. This document does not authorize payments to the Producer. Additional instructions regarding how
to receive payments can be found under the Agreement and Reimbursement Process on page 3.
The Producer may request modifications to these procedures at any time by contacting the AVIC or SAHO (or
designee). The procedures in this document will remain in effect until USDA APHIS VS approves modifications to this
agreement.
☐ The Producer has been presented with the option and declines to participate in the financial support options for

HPAI affected premises at this time.

AVAILABLE SUPPORT OPTIONS FOR HPAI AFFECTED PREMISES (PRODUCER TO SELECT
DESIRED OPTIONS)

☐ PROTECT AGAINST THE POTENTIAL FOR SPREAD BETWEEN HUMAN AND ANIMALS. Provide financial

support (up to $2,000 per affected premises per month) for the Producer to supply PPE to employees and/or
provide outerwear uniform laundering. The Producer will facilitate the participation of their workers in USDA/CDC
workplace and farmworker study.
If this option is elected, a flat rate per employee will be offered to the Producer, up to $2,000 per affected
premises per month. The Producer will need to provide proof of purchase of PPE and/or the cost of
laundering services as well as acknowledgement from CDC of their participation in the study.
Note – participation in the CDC study is required for the Producer to receive this option. USDA will connect
the Producer with CDC or local public health point of contact.

☐ SUPPORT FOR BIOSECURITY PLANNING AND IMPLEMENTATION. Provide support (up to $1,500 per

affected premises) to develop and implement biosecurity plans based on existing secure milk supply plans. This
includes recommended enhanced biosecurity for individuals that frequently move between dairy farms – milk
haulers, veterinarians, feed trucks, AI technicians, etc. In addition, USDA will provide financial support to the
Producer to purchase and use an in-line sampler for their milk system, up to $100 per premises.
If the Producer elects to hire private entities to develop site specific plans, conduct biosecurity trainings,
and perform audits: the Producers will be compensated up to $1,500 per premises for these services after
verification and inclusion on the Dairy HPAI Expense Tracker. The Producer will need to provide proof of
contract/purchase of biosecurity planning. APHIS may conduct onsite visits to verify implementation of
the biosecurity plan.
If the Producer elects to work with State Animal Health personnel to develop site specific plans, conduct
biosecurity trainings, and perform audits, this service by the State will be free to the Producer: USDA will
compensate States directly for this service.
The Producer will need to provide receipt for proof of purchase and installation of the in-line sampler.

Owner Initials: _ (ink)
Version: May 29, 2024

pg. 2

☐ PROVIDE FUNDING FOR HEAT TREATMENT TO DISPOSE OF WASTE MILK IN A BIO SECURE
FASHION. This will provide the Producer with a safe option for disposal of waste milk. Heat treatment performed

in accordance with standards set by FDA is the only currently available method considered to effectively inactivate
the virus in milk. If the Producer establishes a system to heat treat all waste milk before disposal, USDA will pay the
producer up to $8,000 total per affected premises.
The Producer will need to provide receipts for this purchase. APHIS may conduct onsite visits to verify the
system is in operation during the duration of the time the producer receives payments.

☐ REIMBURSE THE PRODUCER FOR VETERINARY COSTS ASSOCIATED WITH CONFIRMED POSITIVE
H5N1 PREMISES. This provides support to the Producer to cover veterinary costs incurred for treatment of

cattle infected with H5N1, as well as fees for veterinarians to collect samples for H5N1 testing. This can include
veterinary fees and/or specific supplies needed for treatment and sample collection. Veterinary costs are eligible
to be covered from the initial date of positive confirmation at NVSL for the premises, up to $10,000 per affected
premises for up to 120 days.
The Producer will need to provide evidence of veterinary supply receipts and/or paid veterinary bills
associated with treatment of sick cattle and/or sample collection.

☐ OFFSET SHIPPING COSTS FOR INFLUENZA A TESTING AT LABORATORIES IN THE NATIONAL
ANIMAL HEALTH LABORATORY NETWORK (NAHLN). USDA will pay for the cost of shipping samples to

NAHLN labs for testing. USDA will pay actual shipping costs, not to exceed $50 per shipment, for up to 2 shipments
per month for each affected premises. Testing at NAHLN laboratories for samples associated with this event (e.g.,
pre-movement, testing of sick/suspect animals, samples from concerned producers) is already being conducted at
no-cost to the producer.
The Producer will need to provide receipts for sample shipping costs.

AGREEMENT AND REIMBURSEMENT PROCESSES

Upon signature of this agreement, the Producer will be provided with information to sign up for a System for
Award Management (SAM) registration, which will provide for the mechanism of payment, or offered an
alternative method of payment (e.g., providing an EFT form for direct deposit payments, requesting a paper check
be drafted), although these other options will result in less timely payments compared to SAM.
Additionally, an APHIS representative will work with the Producer to develop a detailed financial plan to include all
the planned activities, purchases and services that will be eligible for reimbursement.
Every 30 days, the Producer will be provided a form (VS 8-18) to review and sign verifying the request for
reimbursement. The Producer may also elect to be reimbursed one time at the end of the 120 days. The Producer
will keep all receipts and will be required to present receipts with the 8-18.

OPTIONS FOR REIMBURSEMENT
☐ MONTHLY REIMBURSEMENT

☐ ONE TIME PAYMENT AT THE END OF 120 DAYS
Owner Initials:

(ink)

Version: May 29, 2024

pg. 3