Private Sector

HPAI: Testing, Surveillance, and Reporting of HPAI in Livestock; Dairy Herd Certification

Documents and Forms

Document Name Document Type
Form VS 12-1 Private Sector Form and Instruction
HPAI Livestock Non-NAHLN Lab Reporting Results Template JUL 2024 (20241210).xlsx Other-temporary form
Dairy Cattle Emerging Health Event Epi Questionnaire APR 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
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
Biosecurity Plan Template SEP 2023 (20241210).docx Other-template
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 HPAI H5N1 Milk Submission Form NOV 2024 (20241210).pdf Form and Instruction
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

Information Collection (IC) Details

IC Title:	Private Sector	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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VS 12-1	HPAI H5N1 Milk Submission Form	VS 12-1 HPAI H5N1 Milk Submission Form NOV 2024 (20241210).pdf	No		Fillable Fileable
Other-temporary form			HPAI Livestock Non-NAHLN Lab Reporting Results Template JUL 2024 (20241210).xlsx	Yes	Yes	Fillable Fileable
Other-temporary form			Dairy Cattle Emerging Health Event Epi Questionnaire APR 2024 (20241210).pdf	Yes	Yes	Fillable Fileable
Other-temporary form			Herd Monitoring Plan Template SEP 2024 (20241210).pdf	Yes	Yes	Fillable Fileable
Form	VS 8-18	Statement of Services Performed	VS 8-18 AUG 2023 (20241210).pdf	Yes	Yes	Fillable Printable
Other-temporary form			Dairy HPAI Expense Tracker JUN 2024 (20241210).xlsx	Yes	Yes	Fillable Fileable
Other-temporary form			Financial Support - HPAI Affected Dairy Premises Agreement AUG 2024 (20241210).pdf	Yes	Yes	Fillable Printable
Other-temporary form			Financial Support - Participating Premises Agreement AUG 2024 (20241210).pdf	Yes	Yes	Fillable Printable
Other-template			Biosecurity Plan Template SEP 2023 (20241210).docx	Yes	Yes	Fillable Fileable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 3,000

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms

Percentage of Respondents Reporting Electronically: 75 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	69,000	-31,200	100,200
Annual IC Time Burden (Hours)	366,000	-13,200	379,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.