Private Sector

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Overview

DIRECTIONS
Financial-Option 1
Financial-Option 2
Financial-Option 3
Financial-Option 4
Financial-Option 5
Labor Worksheet
Financial Plan- Option 2.1
Financial Plan- Option 4.1
Financial Plan- Option 5.1

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Sheet 1: DIRECTIONS

Paperwork Reduction Act
OMB Approved 0579-0494, Expires XX/XXXX
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 0579-0494. The time required to complete this information collection is estimated to average 2 to 18 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. Send comments regarding this burden statement or any other aspect of this information collection, including suggestions for reducing this burden, to [email protected].

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Sheet 2: Financial-Option 1

AFFECTED -Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #1- Protect Against the Potential Spread Between Human and Animals
PPE Costs
Disposable PPE ($10.00/set)
Uniform laundering
Number of workers per farm
Other costs (details required)
Other costs (details required)
Other costs (details required)
Total PPE Costs (in $):	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Details of Costs:
A flat rate per employee per PPE set will be offered to producers who elect this option, up to $2,000 per affected premises per month.
Producers will need to provide proof of purchase of PPE or the cost of laundering services as well as acknowledgement from CDC of their participation in the study.
				Supplies	TOTAL	$0.00

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Sheet 3: Financial-Option 2

AFFECTED- Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #2-Support for Biosecurity Planning and Implementation
Biosecurity Plan Costs
Private Entities (if applicable)
Number of workers
Hours per worker
Wage ($/hour)
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Biosecurity Plan Costs (in $):	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor- Biosecurity Plan		TOTAL
Biosecurity Implementation
Biosecurity training
(Training)Hours per worker
(Training) Wage ($/hour)
Biosecurity Audit
In-Line Sampler for Milk System
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Biosecurity Implementation Costs (in $):	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor- Biosecurity Implementation		TOTAL
Details of Costs:
Producers can elect to hire private entities to develop site specific plans, conduct biosecurity trainings, and perform audits.
Producers would be compensated up to $1,500 per affected premises for these services after verification and inclusion on the Dairy HPAI Expense Tracker.
Producers could elect to work with State personnel who would develop site specific plans, conduct biosecurity trainings, and perform audits.
States would be compensated under a cooperative agreement based on the flat rates for activities chosen by the Producer.
USDA will provide a $100 payment to producers who purchase and install an in-line sampler for their milk system on an affected premises.
					TOTAL	$0.00

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Sheet 4: Financial-Option 3

AFFECTED -Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #3-Funding for Heat Treatment to Dispose of Waste Milk in a Biosecure Method
Supplies to prepare for or conduct heat treatment for milk
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Equipment and Supplies (in $):	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Details of Costs:
If a producer establishes a system to heat treat all waste milk from sick cows before disposal, USDA will pay the producer up to $2,000 per month, up to $8,000 total, per affected premises.
				Supplies	TOTAL	$0.00

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Sheet 5: Financial-Option 4

AFFECTED- Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #4-Veterinary Costs Associated with Confirmed Positive H5N1 Premises
Labor for Veterinary Care
Number of workers
Hours per worker
Wage ($/hour)
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Labor for Veterinary Care(in $):	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor - Veterinary Care		TOTAL	$0.00
Labor for Veterinary Care
Number of Veterinarians
Hours per Veterinarian
Farm Call Flat Rate
Wage ($/hour)
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Labor for Veterinarian (in $):	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor - Veterinary Care		TOTAL	$0.00
Veterinary - Supplies
Supplies to treat cattle (e.g. fluids, electrolytes, supplements)
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Total Equipment and Supplies (in $):	$0.00	$0.00	$0.00	$0.00	$0.00
			Supplies-Veterinary		TOTAL	$0.00
Details of Costs:
This can include veterinary fees and/or specific supplies needed for treatment and sample collection.
Veterinary costs are eligible for reimbursement from 120 days from the initial date of confirmation at the NVSL, up to $10,000 per premises.
					TOTAL	$0.00

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Sheet 6: Financial-Option 5

AFFECTED- Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #5- Offset Shipping Costs for Influenza A Testing at Laboratories in the NAHLN
Shipping Costs (Does NOT include supplies)
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Total Shipping Costs (in $):	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Details of Costs:
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.
This total may include shipping supplies.
NAHLN= National Animal Health Laboratory Network
			Costs- Shipping		TOTAL	$0.00

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Sheet 7: Labor Worksheet

Labor
Date	# Workers per day	Number of hours per worker										Total hours worked per day	Activities Performed
		1	2	3	4	5	6	7	8	9	10
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
												0
Total												0

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Sheet 8: Financial Plan- Option 2.1

NON-AFFECTED- Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #2-Support for Biosecurity Planning and Implementation
Biosecurity Plan Costs
Private Entities (if applicable)
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Biosecurity Plan Costs (in $):	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor- Biosecurity Plan		TOTAL
Biosecurity Implementation
Biosecurity training
(Training)Hours per worker
(Training) Wage ($/hour)
Number of workers
Hours per worker
Wage ($/hour)
Biosecurity Audit
In-Line Sampler for Milk System
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Biosecurity Implementation Costs (in $):	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor- Biosecurity Implementation		TOTAL
Details of Costs:
Producers can elect to hire private entities to develop site specific plans, conduct biosecurity trainings, and perform audits.
Producers would be compensated up to $1,500 per affected premises for these services after verification and inclusion on the Dairy HPAI Expense Tracker.
Producers could elect to work with State personnel who would develop site specific plans, conduct biosecurity trainings, and perform audits.
States would be compensated under a cooperative agreement based on the flat rates for activities chosen by the Producer.
USDA will provide a $100 payment to Producers who purchase and install an in-line sampler for their milk system on an affected premises.
The Producer will need to provide receipt for proof of purchase and installation of the in-line sampler.
					TOTAL	$0.00

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Sheet 9: Financial Plan- Option 4.1

NON-AFFECTED- Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #4-Veterinary Costs Associated with Sample Collection for H5N1 Testing
Labor for Veterinary Care
Number of workers
Hours per worker
Wage ($/hour)
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Labor for Veterinary Care(in $):	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor - Veterinary Care		TOTAL	$0.00
Labor for Veterinary Care
Number of Veterinarians
Hours per Veterinarian
Farm Call Flat Rate
Wage ($/hour)
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Other Costs- Description of Item/Cost per Item:
Total Labor for Veterinarian (in $):	$0.00	$0.00	$0.00	$0.00	$0.00
			Labor - Veterinary Care		TOTAL	$0.00
Veterinary - Supplies
Supplies to treat cattle (e.g. fluids, electrolytes, supplements)
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Total Equipment and Supplies (in $):	$0.00	$0.00	$0.00	$0.00	$0.00
			Supplies-Veterinary		TOTAL	$0.00
Details of Costs:
This can include veterinary fees and/or specific supplies needed for H5N1 sample collection.
Veterinary sample collection costs are eligible to be covered from the April 29, 2024 (the date the Federal Order went into effect) for that premises, up to $2,000 per premises.
The Producer will need to provide paid veterinary bills associated with sample collection.
					TOTAL	$0.00

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Sheet 10: Financial Plan- Option 5.1

NON-AFFECTED- Dairy HPAI Expense Tracker
Special ID:		Premises ID Number:
RECEIPTS, INVOICES, AND EMPLOYEE LOG SHEETS MUST BE SUBMITTED TO VALIDATE THE FOLLOWING EXPENSES. USDA DOES NOT REIMBURSE THE PURCHASE OF EQUIPMENT. USDA REIMBURSES NECESSARY EQUIPMENT RENTED FOR A TIMEFRAME COMMENSURATE WITH REIMBURSABLE TASKS. HOURLY EQUIPMENT RATES INCLUDE EQUIPMENT, OPERATOR, AND FUEL.
Support Option #5- Offset Shipping Costs for Influenza A Testing at Laboratories in the NAHLN
Shipping Costs (Does NOT include supplies)
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Description of Item/Cost per Item:
Total Shipping Costs (in $):	$0.00	$0.00	$0.00	$0.00	$0.00
			Costs- Shipping		TOTAL	$0.00
Details of Costs:
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.
This total may include shipping supplies.
NAHLN= National Animal Health Laboratory Network
			Costs- Shipping		TOTAL	$0.00