Information Collection

State, Local, Tribal Gov't

IC 268874 under ICR 202406-0579-002 · OMB 0579-0494.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0494 can be found here:

2024-12-17 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HPAI H5N1 Milk Submission Form.pdf	Other-temporary form
HPAI H5N1 Milk Submission Form.pdf	Other-temporary form
HPAI Livestock Non-NAHLN Lab Reporting Results Template.xlsx	Other-temporary form
HPAI Livestock Non-NAHLN Lab Reporting Results Template.xlsx	Other-temporary form
Dairy Cattle Emerging Health Event Epi Questionnaire.pdf	Other-temporary form
Dairy Cattle Emerging Health Event Epi Questionnaire.pdf	Other-temporary form
Herd Monitoring Plan Template.pdf	Other-temporary form
Herd Monitoring Plan Template.pdf	Other-temporary form
Dairy HPAI Expense Tracker.xlsx	Other-temporary form
Dairy HPAI Expense Tracker.xlsx	Other-temporary form
Financial Support - HPAI Affected Dairy Premises Agreement.pdf	Other-temporary form
Financial Support - HPAI Affected Dairy Premises Agreement.pdf	Other-temporary form
Financial Support - Participating Premises Agreement.pdf	Other-temporary form
Financial Support - Participating Premises Agreement.pdf	Other-temporary form
VS 10-4 Specimen Submission VS 10-4 JUN 2022-ICR-FIL-508-RE.pdf	Form and Instruction
VS 10-4 Specimen Submission VS 10-4 JUN 2022-ICR-FIL-508-RE.pdf	Form and Instruction
VS 10-4A Continuation Sheet for Specimen Submission VS 10-4A AUG 2009-ICR-FIL-508-RE.pdf	Form and Instruction
VS 10-4A Continuation Sheet for Specimen Submission VS 10-4A AUG 2009-ICR-FIL-508-RE.pdf	Form and Instruction
VS 1-27 Permit for Movement of Restricted Animals VS 1-27 JUL 2011-ICR-FIL-508-RE.pdf	Form and Instruction
VS 1-27 Permit for Movement of Restricted Animals VS 1-27 JUL 2011-ICR-FIL-508-RE.pdf	Form and Instruction
VS 1-27A Continuation Sheet for Permit for Movement of Restricted VS 1-27A SEP 1991-ICR-FIL-508-RE.pdf	Form and Instruction
VS 1-27A Continuation Sheet for Permit for Movement of Restricted VS 1-27A SEP 1991-ICR-FIL-508-RE.pdf	Form and Instruction
VS 8-18 Statement of Services Performed VS 8-18 AUG 2023.pdf	Form
VS 8-18 Statement of Services Performed VS 8-18 AUG 2023.pdf	Form
USDA Support to HPAI-Affected Premises.pdf USDA Support to HPAI-Affected Premises	IC Document
USDA Support to HPAI-Affected Premises.pdf USDA Support to HPAI-Affected Premises	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State, Local, Tribal Gov't

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 9 CFR 71.3(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-temporary form			HPAI H5N1 Milk Submission Form.pdf	Yes	Yes	Fillable Fileable
Other-temporary form			HPAI Livestock Non-NAHLN Lab Reporting Results Template.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	VS 10-4	Specimen Submission	VS 10-4 JUN 2022-ICR-FIL-508-RE.pdf	Yes	Yes	Fillable Printable
Form and Instruction	VS 10-4A	Continuation Sheet for Specimen Submission	VS 10-4A AUG 2009-ICR-FIL-508-RE.pdf	Yes	Yes	Fillable Printable
Other-temporary form			Dairy Cattle Emerging Health Event Epi Questionnaire.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VS 1-27	Permit for Movement of Restricted Animals	VS 1-27 JUL 2011-ICR-FIL-508-RE.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VS 1-27A	Continuation Sheet for Permit for Movement of Restricted Animals	VS 1-27A SEP 1991-ICR-FIL-508-RE.pdf	Yes	Yes	Fillable Fileable
Other-temporary form			Herd Monitoring Plan Template.pdf	Yes	Yes	Fillable Fileable
Form	VS 8-18	Statement of Services Performed	VS 8-18 AUG 2023.pdf	Yes	Yes	Fillable Printable
Other-temporary form			Dairy HPAI Expense Tracker.xlsx	Yes	Yes	Fillable Fileable
Other-temporary form			Financial Support - HPAI Affected Dairy Premises Agreement.pdf	Yes	Yes	Fillable Printable
Other-temporary form			Financial Support - Participating Premises Agreement.pdf	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	36,304	36,304
Annual IC Time Burden (Hours)	138,866	138,866
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
USDA Support to HPAI-Affected Premises	USDA Support to HPAI-Affected Premises.pdf	06/21/2024

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