Information Collection

State, Tribal, Local Government

IC 199210 under ICR 202107-0579-003 · OMB 0579-0189.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0189 can be found here:

Documents and Forms

Document Name Document Type
Form VS 11-2 State, Tribal, Local Government Form
VS 11-2 Application for Chronic Wasting Disease Herd Certifcatio VS 11-2 AUG 2012 SECURE.pdf www.aphis.usda.gov/library/forms/pdf/VS11_2.pdf Form
VS 10-4 Specimen Submission VS 10-4 FEB 2021 SEC.pdf www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State, Tribal, Local Government	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 81.2 - 81.4 9 CFR 55.1 - 55.25

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VS 11-2	Application for Chronic Wasting Disease Herd Certifcation Program (CWD HCP) Approval, Renewal, or Reinstatement of a State	VS 11-2 AUG 2012 SECURE.pdf	http://www.aphis.usda.gov/library/forms/pdf/VS11_2.pdf	Yes	No	Fillable Printable
Form	VS 10-4	Specimen Submission	VS 10-4 FEB 2021 SEC.pdf	https://www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Yes	No	Fillable Printable

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	30,205	190	-30,835	60,850
Annual IC Time Burden (Hours)	71,525	1,508	-24,110	94,127
Annual IC Cost Burden (Dollars)	0	0	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.