State

Center for Epidemiology and Animal Health (CEAH), National Animal Health Monitoring System (NAHMS) Data Security Requirements for Accessing Confidential Data

Documents and Forms

Document Name Document Type
NAHMS Agent Agreement (20250113).docx Other-Agreement
NAHMS Site Inspection Checklist (20250113).docx Other-Checklist
NASS ADM-043 Certification and Restrictions on Use of Unpublished Dat NASS ADM-043, Certification and Restrictions on Use of Unpublished Data.pdf Form
NASS ADM-044 User Attestation Form NASS ADM-044, User Attestation Form.pdf Form
NASS ADM-045 Site Inspection Checklist NASS ADM-045, Site Inspection Checklist.pdf Form
NAHMS SAP Data Security Requirements - Index of ICR and Supplemental Materials.docx NAHMS SAP Data Security Requirements Index of ICR and Supplemental Materials IC Document

Information Collection (IC) Details

IC Title:	State	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Agreement			NAHMS Agent Agreement (20250113).docx	Yes	Yes	Fillable Fileable Signable
Other-Checklist			NAHMS Site Inspection Checklist (20250113).docx	Yes	Yes	Fillable Fileable Signable
Form	NASS ADM-043	Certification and Restrictions on Use of Unpublished Data	NASS ADM-043, Certification and Restrictions on Use of Unpublished Data.pdf	Yes	Yes	Fillable Fileable Signable
Form	NASS ADM-044	User Attestation Form	NASS ADM-044, User Attestation Form.pdf	Yes	Yes	Fillable Fileable Signable
Form	NASS ADM-045	Site Inspection Checklist	NASS ADM-045, Site Inspection Checklist.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	26	26
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NAHMS SAP Data Security Requirements Index of ICR and Supplemental Materials	NAHMS SAP Data Security Requirements - Index of ICR and Supplemental Materials.docx	01/06/2025

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