Information Collection

State, Local, Tribal Gov't

IC 268874 under ICR 202412-0579-002 · OMB 0579-0494.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VS 12-1 State, Local, Tribal Gov't	Form
Form VS 12-1 HPAI H5N1 Milk Submission Form State, Local, Tribal Gov't	Form
Form VS 8-18 Statement of Services Performed State, Local, Tribal Gov't	Form
HPAI Livestock Non-NAHLN Lab Reporting Results Template JUL 2024 (20241210).xlsx	Other-temporary form
HPAI Livestock Non-NAHLN Lab Reporting Results Template JUL 2024 (20241210).xlsx	Other-temporary form
Herd Monitoring Plan Template SEP 2024 (20241210).pdf	Other-temporary form
Herd Monitoring Plan Template SEP 2024 (20241210).pdf	Other-temporary form
Dairy HPAI Expense Tracker JUN 2024 (20241210).xlsx	Other-temporary form
Dairy HPAI Expense Tracker JUN 2024 (20241210).xlsx	Other-temporary form
Financial Support - HPAI Affected Dairy Premises Agreement AUG 2024 (20241210).pdf	Other-temporary form
Financial Support - HPAI Affected Dairy Premises Agreement AUG 2024 (20241210).pdf	Other-temporary form
Financial Support - Participating Premises Agreement AUG 2024 (20241210).pdf	Other-temporary form
Financial Support - Participating Premises Agreement AUG 2024 (20241210).pdf	Other-temporary form
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 HPAI H5N1 Milk Submission Form NOV 2024 (20241210).pdf	Form
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 HPAI H5N1 Milk Submission Form NOV 2024 (20241210).pdf	Form
VS 8-18 Statement of Services Performed VS 8-18 AUG 2023 (20241210).pdf	Form
VS 8-18 Statement of Services Performed VS 8-18 AUG 2023 (20241210).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: Modified

Obligation to Respond: Mandatory

CFR Citation: 9 CFR 71.3(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VS 12-1	No		Fillable Fileable
Other-temporary form		Yes	Yes	Fillable Fileable
Other-temporary form		Yes	Yes	Fillable Fileable
Form	VS 8-18	Yes	Yes	Fillable Printable
Other-temporary form		Yes	Yes	Fillable Fileable
Other-temporary form		Yes	Yes	Fillable Printable
Other-temporary form		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	Previously Approved
Annual Number of Responses for this IC	35,504	-800	36,304
Annual IC Time Burden (Hours)	137,000	-1,866	138,866
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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

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

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