Information Collection

Private Sector

IC 2183 under ICR 201611-0579-005 · OMB 0579-0101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0101 can be found here:

2025-02-10 - No material or nonsubstantive change to a currently approved collection
2024-10-10 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form VS 5-18 Private Sector Form
VS 5-18 Record of Animals Moved VS 5-18 Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf Form
VS 5-19D Scrapie Epidemiology Report VS 5-19D Feb_FINAL.doc Form
VS 5-19 Flock Inspection and Epidemiology Report VS 5-19 DEC 2011.pdf Form
VS 5-20 Individual Animal Information Report VS 5-20 DEC 2011.pdf Form
VS 1-23 Appraisal and Indemnity Claim Form REV VS 1-23 Sep 2010.pdf Form
VS 1-23A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.doc Form
VS 1-24 Proceeds from Animals Sold for Slaughter VS 1-24 DEC 2011.docx Form
VS 5-19C Scrapie PEMMP Inspection Report VS 5-19C Feb_FINAL.pdf Form
VS 5-29 Cooperative State - Scrapie Control Program VS 5-29 DEC 2011.pdf Form
VS 5-29 A Scrapie Test Record - Continuation Sheet VS 5-29A DEC 2011.pdf Form
VS 10-4 Specimen Submission VS 10-4 Aug 2009.doc www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf Form
VS 5-22 Application for the Scrapie Flock Certification Program REV VS 5-22 June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/vs5_22.pdf Form
VS 5-18 A Record of Animals Acquired VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf Form
VS 5-19 A Flock Inspection and Epidemnity Report Initial Flock Ins REV VS 5-19A June 2013 Final.pdf Form
VS 5-19 b Flock Inspection and Epidemiology Report Flock Inspectio REV VS 5-19B June 2013 Final.pdf Form
VS 17-140 United States Origin Health Certificate REV VS 17-140 NOV 2014.pdf Form
VS 1-27 Permit for Movement of Restricted Animals VS 1-27 JUL 2011.doc Form
How to Create an On-Line CVI for AV.ppt How to Create an On-Line CVI for AV IC Document
Appendix A-1 FY 2010 Scrapie CA Guidance.docx Appendix A-1 FY 2010 Scrapie CA Guidance IC Document
Appendix A-2 Coop Agreement Award ASI 10-9100-1231.pdf Appendix A-2 Coop Agreement Award ASI 10-9100-1231 IC Document
Appendix A-3 NIAAGrant.pdf Appendix A-3 NIAAGrant IC Document
Appendix A-4_ MOU template for scrapie.doc Appendix A-4_ MOU template for scrapie IC Document
Appendix B_10-4 and 5-29 worksheets.docx Appendix B_10-4 and 5-29 worksheets IC Document
Appendices C-E screenshots.doc Appendices C-E screenshots IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Private Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 9 CFR 54.2 - 54.21, 79.2 - 79.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VS 5-18	Record of Animals Moved	VS 5-18 Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf	Yes	No	Printable Only
Form	VS 5-19D	Scrapie Epidemiology Report	VS 5-19D Feb_FINAL.doc		No		Paper Only
Form	VS 5-19	Flock Inspection and Epidemiology Report	VS 5-19 DEC 2011.pdf		No		Paper Only
Form	VS 5-20	Individual Animal Information Report	VS 5-20 DEC 2011.pdf		No		Paper Only
Form	VS 1-23	Appraisal and Indemnity Claim Form	REV VS 1-23 Sep 2010.pdf		No		Paper Only
Form	VS 1-23A	Indemnity Worksheet - Owner/Company	VS 1-23A-work May 2009.doc		No		Paper Only
Form	VS 1-24	Proceeds from Animals Sold for Slaughter	VS 1-24 DEC 2011.docx		No		Paper Only
Form	VS 5-19C	Scrapie PEMMP Inspection Report	VS 5-19C Feb_FINAL.pdf		No		Paper Only
Form	VS 5-29	Cooperative State - Scrapie Control Program	VS 5-29 DEC 2011.pdf		No		Paper Only
Form	VS 5-29 A	Scrapie Test Record - Continuation Sheet	VS 5-29A DEC 2011.pdf		No		Paper Only
Form	VS 10-4	Specimen Submission	VS 10-4 Aug 2009.doc	http://www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Yes	No	Printable Only
Form	VS 5-22	Application for the Scrapie Flock Certification Program	REV VS 5-22 June 2013 Final.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_22.pdf	Yes	No	Printable Only
Form	VS 5-18 A	Record of Animals Acquired	VS 5-18A Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf	Yes	No	Printable Only
Form	VS 5-19 A	Flock Inspection and Epidemnity Report Initial Flock Inspection for Complete Monitored Status in SCrapie Flock Certification Program	REV VS 5-19A June 2013 Final.pdf		No		Paper Only
Form	VS 5-19 b	Flock Inspection and Epidemiology Report Flock Inspection for Complete Monitored Status in the Scrapie Flock Certification Program	REV VS 5-19B June 2013 Final.pdf		No		Paper Only
Form	VS 17-140	United States Origin Health Certificate	REV VS 17-140 NOV 2014.pdf		No		Paper Only
Form	VS 1-27	Permit for Movement of Restricted Animals	VS 1-27 JUL 2011.doc		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title: Animal health Surveillance and Monitoring System	FR Citation: 76 FR 228

Number of Respondents: 56,934	Number of Respondents for Small Entity: 55,000

Affected Public: Private Sector	Private Sector: Farms, Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	853,731	853,731
Annual IC Time Burden (Hours)	958,989	958,989
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
How to Create an On-Line CVI for AV	How to Create an On-Line CVI for AV.ppt	11/15/2012
Appendix A-1 FY 2010 Scrapie CA Guidance	Appendix A-1 FY 2010 Scrapie CA Guidance.docx	11/15/2012
Appendix A-2 Coop Agreement Award ASI 10-9100-1231	Appendix A-2 Coop Agreement Award ASI 10-9100-1231.pdf	11/15/2012
Appendix A-3 NIAAGrant	Appendix A-3 NIAAGrant.pdf	11/15/2012
Appendix A-4_ MOU template for scrapie	Appendix A-4_ MOU template for scrapie.doc	11/15/2012
Appendix B_10-4 and 5-29 worksheets	Appendix B_10-4 and 5-29 worksheets.docx	11/15/2012
Appendices C-E screenshots	Appendices C-E screenshots.doc	11/15/2012

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