Information Collection

NAHMS Emergency Highly Pathogenic Avian Influenza Epidemiologic Investigation

IC 216037 under ICR 201403-0579-005 · OMB 0579-0376.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0376 can be found here:

Documents and Forms

Document Name Document Type
Form VS 17-5 NAHMS Emergency Highly Pathogenic Avian Influenza Epidemiologic Investigation Form
VS 17-5 Highly Pathogenic Avian Influenza (HPAI) Investigation - VS 17-5 APR 2015.pdf Form
HPAI EEI 2015 Part B.docx Part B of the Supporting Statement IC Document
HPAI 2015 APHIS 71.xls APHIS 71 IC Document
HPAI 2015 APHIS 79.xlsx APHIS 79 IC Document
HPAI EEI 2015 Part A.doc Part A of the Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NAHMS Emergency Highly Pathogenic Avian Influenza Epidemiologic Investigation	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 9 CFR 1-199 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VS 17-5	Highly Pathogenic Avian Influenza (HPAI) Investigation - Questionaire	VS 17-5 APR 2015.pdf		No		Paper Only

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	181	181
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Part B of the Supporting Statement	HPAI EEI 2015 Part B.docx	04/23/2015
APHIS 71	HPAI 2015 APHIS 71.xls	04/23/2015
APHIS 79	HPAI 2015 APHIS 79.xlsx	04/23/2015
Part A of the Supporting Statement	HPAI EEI 2015 Part A.doc	04/24/2015

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