Information Collection

State, Local, or Tribal Government

IC 184526 under ICR 202410-0579-003 · OMB 0579-0101.

⚠️ Notice: This information collection may be referencing outdated material.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

2025-02-10 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VS 5-18 State, Local, or Tribal Government	Form
Form VS 5-18 Record of Animals Moved State, Local, or Tribal Government	Form
Form VS 5-19 FLOCK INSPECTION AND EPIDEMIOLOGY REPORT State, Local, or Tribal Government	Form
Form VS 5-19 D Scrapie Epidemiology Report State, Local, or Tribal Government	Form
Form VS 5-20 Individual Animal Information Report State, Local, or Tribal Government	Form
Form VS 1-23 Appraisal and Indemnity Claim Form State, Local, or Tribal Government	Form
Form VS 1-23 A Indemnity Worksheet - Owner/Company State, Local, or Tribal Government	Form
Form VS 5-19C Scrapie PEMMP Inspection Report State, Local, or Tribal Government	Form
Form VS 5-29 Cooperative State - Scrapie Control Program State, Local, or Tribal Government	Form
Form Vs 5-29A Scrapie Test Record - Continuation Sheet State, Local, or Tribal Government	Form
Form VS 10-4 Specimen Submission State, Local, or Tribal Government	Form
Form Vs 5-19A Flock Inspection and Epidemiology Report Initial Flcok Inspection for Complete Monitored Status in Scrapie Flock Certification Program State, Local, or Tribal Government	Form
Form Vs 5-19b Flock Inspection and Epidemiology Report Flock Inspection for Complete Monitored Status in the Scrapie Flock Certification Program State, Local, or Tribal Government	Form
Form VS 5-24 Application for Scrapie Classification, Classification Renewal, or Reclassification of a State State, Local, or Tribal Government	Form
Form VS 5-18A RECORD OF ANIMALS ACQUIRED State, Local, or Tribal Government	Form
Form VS 1-27 PERMIT FOR MOVEMENT OF RESTRICTED ANIMALS State, Local, or Tribal Government	Form
Form VS 17-140 UNITED STATES ORIGIN HEALTH CERTIFICATE State, Local, or Tribal Government	Form
Form VS 10-4A Continuation Sheet for Specimen Submission State, Local, or Tribal Government	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 5-19 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 5-19 D Scrapie Epidemiology Report VS 5-19D Feb 2011.pdf	Form
VS 5-19 D Scrapie Epidemiology Report VS 5-19D Feb 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 1-23 A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.doc	Form
VS 1-23 A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.doc	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 NSC - VS 5-29 JUL 2024-ICR-FIL (20240701).pdf	Form
VS 5-29 Cooperative State - Scrapie Control Program NSC - VS 5-29 JUL 2024-ICR-FIL (20240701).pdf	Form
Vs 5-29A Scrapie Test Record - Continuation Sheet NSC - VS 5-29A JUL 2024-ICR-FIL (20240701).pdf	Form
Vs 5-29A Scrapie Test Record - Continuation Sheet NSC - VS 5-29A JUL 2024-ICR-FIL (20240701).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 5-19A Flock Inspection and Epidemiology Report Initial Flcok I VS 5-19A June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19A.pdf	Form
Vs 5-19A Flock Inspection and Epidemiology Report Initial Flcok I VS 5-19A June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19A.pdf	Form
Vs 5-19b Flock Inspection and Epidemiology Report Flock Inspectio VS 5-19B June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19B.pdf	Form
Vs 5-19b Flock Inspection and Epidemiology Report Flock Inspectio VS 5-19B June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19B.pdf	Form
VS 5-24 Application for Scrapie Classification, Classification R VS 5-24 (AUG 2010)(SECURE).pdf	Form
VS 5-24 Application for Scrapie Classification, Classification R VS 5-24 (AUG 2010)(SECURE).pdf	Form
VS 5-18A RECORD OF ANIMALS ACQUIRED VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_18A.pdf	Form
VS 5-18A RECORD OF ANIMALS ACQUIRED VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_18A.pdf	Form
VS 1-27 PERMIT FOR MOVEMENT OF RESTRICTED ANIMALS VS 1-27 JUL 2011.doc www.aphis.usda.gov/library/forms	Form
VS 1-27 PERMIT FOR MOVEMENT OF RESTRICTED ANIMALS VS 1-27 JUL 2011.doc www.aphis.usda.gov/library/forms	Form
VS 17-140 UNITED STATES ORIGIN HEALTH CERTIFICATE VS 17-140 AUG 2018.pdf www.aphis.usda.gov/library/forms	Form
VS 17-140 UNITED STATES ORIGIN HEALTH CERTIFICATE VS 17-140 AUG 2018.pdf www.aphis.usda.gov/library/forms	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
FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf FY23 Grant and Coop Agreement Guide	IC Document
FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf FY23 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_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 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 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
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
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:

State, Local, or Tribal Government

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 9 CFR 54.2-54.21 and 79.2-79.6

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VS 5-18	http://www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf	Yes	No	Printable Only
Form	VS 5-19		No		Paper Only
Form	VS 5-19 D		No		Paper Only
Form	VS 5-20		No		Paper Only
Form	VS 1-23		No		Paper Only
Form	VS 1-23 A		No		Paper Only
Form	VS 5-19C		No		Paper Only
Form	VS 5-29		No		Fillable Printable
Form	Vs 5-29A		No		Fillable Printable
Form	VS 10-4	http://www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Yes	No	Printable Only
Form	Vs 5-19A	https://www.aphis.usda.gov/library/forms/pdf/VS_5_19A.pdf	Yes	No	Printable Only
Form	Vs 5-19b	https://www.aphis.usda.gov/library/forms/pdf/VS_5_19B.pdf	Yes	No	Printable Only
Form	VS 5-24		No		Paper Only
Form	VS 5-18A	https://www.aphis.usda.gov/library/forms/pdf/VS_5_18A.pdf	Yes	No	Printable Only
Form	VS 1-27	http://www.aphis.usda.gov/library/forms	Yes	No	Printable Only
Form	VS 17-140	http://www.aphis.usda.gov/library/forms	Yes	No	Printable Only
Form	VS 10-4A		Yes	No	Fillable Printable

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: 68

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	18,989	18,989
Annual IC Time Burden (Hours)	17,951	17,951
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FY23 Grant and Coop Agreement Guide		10/10/2023
MOU Template		10/10/2023
On-Farm Worksheet		10/10/2023
VSLS Goat RSSS Collection Worksheet Fill-in		10/10/2023
VSLS Goat RSSS Collection Worksheet Circle		10/10/2023
VSLS Sheep RSSS Collection Worksheet Fill-in		10/10/2023
VSLS Sheep RSSS Collection Worksheet Circle		10/10/2023
Appdx C thru E VSLS AIMS Screenshots		10/10/2023

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

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