Information Collection

AgDiscovery Application - Individuals or Households

IC 189500 under ICR 201812-0579-001 · OMB 0579-0362.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0362 can be found here:

Documents and Forms

Document Name Document Type
Form APHIS FORM 119 AgDiscovery Application - Individuals or Households Form and Instruction
APHIS FORM 119 AgDiscovery Application APHIS FORM 119 AgDiscovery Application.pdf www.aphis.usda.gov/civil_rights/downloads/2018%20AgDiscovery%20Application.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AgDiscovery Application - Individuals or Households	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	APHIS FORM 119	AgDiscovery Application	APHIS FORM 119 AgDiscovery Application.pdf	https://www.aphis.usda.gov/civil_rights/downloads/2018%20AgDiscovery%20Application.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	6,200	6,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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