Information Collection

Private Sector

IC 272959 under ICR 202412-0579-003 · OMB 0579-0496.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0496 can be found here:

Documents and Forms

Document Name Document Type
Form VS 12-1 Private Sector Form and Instruction
Dairy Cattle Emerging Health Event Epi Questionnaire APR 2024 (20241210).pdf Other-Temporary Form
Dairy Cattle Emerging Health Event Epi Questionnaire APR 2024 (20241210).pdf Other-Temporary Form
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 HPAI H5N1 Milk Submission Form NOV 2024 (20241210).pdf Form and Instruction
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 HPAI H5N1 Milk Submission Form NOV 2024 (20241210).pdf Form and Instruction
VS 12-2 HPAI H5N1 Milk Silo Submission Form VS 12-2 HPAI H5N1 Milk Silo Submission Form DEC 2024 (20241211).pdf Form and Instruction
VS 12-2 HPAI H5N1 Milk Silo Submission Form VS 12-2 HPAI H5N1 Milk Silo Submission Form DEC 2024 (20241211).pdf Form and Instruction
NCAH Portal Screenshots.pdf NCAH Portal Screenshots IC Document
NCAH Portal Screenshots.pdf NCAH Portal 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: New

Obligation to Respond: Mandatory

CFR Citation: 9 CFR 71.3(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VS 12-1	HPAI H5N1 Milk Submission Form	VS 12-1 HPAI H5N1 Milk Submission Form NOV 2024 (20241210).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VS 12-2	HPAI H5N1 Milk Silo Submission Form	VS 12-2 HPAI H5N1 Milk Silo Submission Form DEC 2024 (20241211).pdf	Yes	Yes	Fillable Fileable
Other-Temporary Form			Dairy Cattle Emerging Health Event Epi Questionnaire APR 2024 (20241210).pdf	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: 1,500	Number of Respondents for Small Entity: 750

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48,100	48,100
Annual IC Time Burden (Hours)	56,200	56,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NCAH Portal Screenshots	NCAH Portal Screenshots.pdf	12/13/2024

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