Information Collection

State, Local, and Tribal Government

IC 272953 under ICR 202504-0579-003 · OMB 0579-0496.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VS 12-1 State, Local, and Tribal Government	Form and Instruction
Form VS 12-1 HPAI H5N1 Milk Submission Form State, Local, and Tribal Government	Form and Instruction
Form VS 12-2 HPAI H5N1 Milk Silo Submission Form State, Local, and Tribal Government	Form and Instruction
Form VS 12-3 HPAI H5N1 Mandatory USDA Silo Monitoring Supply Order Form State, Local, and Tribal Government	Form
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 NOV 2024-ICR-FIL-508 XXXX.pdf	Form and Instruction
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 NOV 2024-ICR-FIL-508 XXXX.pdf	Form and Instruction
VS 12-2 HPAI H5N1 Milk Silo Submission Form VS 12-2 DEC 2024-ICR-PRINT-508 XXXX.pdf	Form and Instruction
VS 12-2 HPAI H5N1 Milk Silo Submission Form VS 12-2 DEC 2024-ICR-PRINT-508 XXXX.pdf	Form and Instruction
VS 12-3 HPAI H5N1 Mandatory USDA Silo Monitoring Supply Order Fo VS 12-3 DEC 2024-ICR-PRINT-508 XXXX.pdf	Form
VS 12-3 HPAI H5N1 Mandatory USDA Silo Monitoring Supply Order Fo VS 12-3 DEC 2024-ICR-PRINT-508 XXXX.pdf	Form
NCAH Portal Screenshots.pdf NCAH Portal screenshots	IC Document
NCAH Portal Screenshots.pdf NCAH Portal screenshots	IC Document

IC Title:

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 and Instruction	VS 12-1	Yes	Yes	Fillable Fileable
Form and Instruction	VS 12-2	Yes	Yes	Fillable Fileable
Form	VS 12-3	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: 150

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	12,860	2,100	10,760
Annual IC Time Burden (Hours)	8,455	1,950	6,505
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NCAH Portal screenshots		12/13/2024

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

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