Information Collection

State, Local, or Tribal Government

IC 184526 under ICR 202501-0579-005 · OMB 0579-0101.

Documents and Forms

Document Name Document Type
Form VS 5-18 State, Local, or Tribal Government 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 5-18 Record of Animals Moved VS 5-18 Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/vs5_18.pdf Form
VS 5-19 FLOCK INSPECTION AND EPIDEMIOLOGY REPORT VS 5-19 DEC 2011.pdf Form
VS 5-19 FLOCK INSPECTION AND EPIDEMIOLOGY REPORT VS 5-19 DEC 2011.pdf Form
VS 5-19 D Scrapie Epidemiology Report VS 5-19D Feb 2011.pdf Form
VS 5-19 D Scrapie Epidemiology Report VS 5-19D Feb 2011.pdf Form
VS 5-20 Individual Animal Information Report VS 5-20 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 VS 1-23 AUG 2018.pdf Form
VS 1-23 Appraisal and Indemnity Claim Form VS 1-23 AUG 2018.pdf Form
VS 1-23 A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.doc Form
VS 1-23 A Indemnity Worksheet - Owner/Company VS 1-23A-work May 2009.doc Form
VS 5-19C Scrapie PEMMP Inspection Report VS 5-19C Feb 2011.pdf Form
VS 5-19C Scrapie PEMMP Inspection Report VS 5-19C Feb 2011.pdf Form
VS 5-29 Cooperative State - Scrapie Control Program NSC - VS 5-29 JAN 2025-ICR-FIL-508 (20240701).pdf Form
VS 5-29 Cooperative State - Scrapie Control Program NSC - VS 5-29 JAN 2025-ICR-FIL-508 (20240701).pdf Form
Vs 5-29A Scrapie Test Record - Continuation Sheet NSC - VS 5-29A JAN 2025-ICR-FIL-508.pdf Form
Vs 5-29A Scrapie Test Record - Continuation Sheet NSC - VS 5-29A JAN 2025-ICR-FIL-508.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
VS 10-4 Specimen Submission VS 10-4 FEB 2021 SEC.pdf www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf Form
Vs 5-19A Flock Inspection and Epidemiology Report Initial Flcok I VS 5-19A June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19A.pdf Form
Vs 5-19A Flock Inspection and Epidemiology Report Initial Flcok I VS 5-19A June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19A.pdf Form
Vs 5-19b Flock Inspection and Epidemiology Report Flock Inspectio VS 5-19B June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19B.pdf Form
Vs 5-19b Flock Inspection and Epidemiology Report Flock Inspectio VS 5-19B June 2013 Final.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_19B.pdf Form
VS 5-24 Application for Scrapie Classification, Classification R VS 5-24 (AUG 2010)(SECURE).pdf Form
VS 5-24 Application for Scrapie Classification, Classification R VS 5-24 (AUG 2010)(SECURE).pdf Form
VS 5-18A RECORD OF ANIMALS ACQUIRED VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_18A.pdf Form
VS 5-18A RECORD OF ANIMALS ACQUIRED VS 5-18A Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/VS_5_18A.pdf Form
VS 1-27 PERMIT FOR MOVEMENT OF RESTRICTED ANIMALS VS 1-27 JUL 2011.doc www.aphis.usda.gov/library/forms Form
VS 1-27 PERMIT FOR MOVEMENT OF RESTRICTED ANIMALS VS 1-27 JUL 2011.doc www.aphis.usda.gov/library/forms Form
VS 17-140 UNITED STATES ORIGIN HEALTH CERTIFICATE VS 17-140 AUG 2018.pdf www.aphis.usda.gov/library/forms Form
VS 17-140 UNITED STATES ORIGIN HEALTH CERTIFICATE VS 17-140 AUG 2018.pdf www.aphis.usda.gov/library/forms Form
VS 10-4A Continuation Sheet for Specimen Submission VS 10-4A AUG 2009 (20200629) Secure.pdf Form
VS 10-4A Continuation Sheet for Specimen Submission VS 10-4A AUG 2009 (20200629) Secure.pdf Form
FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf FY23 Grant and Coop Agreement Guide IC Document
FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf FY23 Grant and Coop Agreement Guide IC Document
MOU template.docx MOU Template IC Document
MOU template.docx MOU Template IC Document
On-farm_worksheet.pdf On-Farm Worksheet IC Document
On-farm_worksheet.pdf On-Farm Worksheet IC Document
VSLS Goat RSSS_Collection_worksheet_Fill in.pdf VSLS Goat RSSS Collection Worksheet Fill-in IC Document
VSLS Goat RSSS_Collection_worksheet_Fill in.pdf VSLS Goat RSSS Collection Worksheet Fill-in IC Document
VSLS Goat RSSS_Collection_worksheet_Circle choice.pdf VSLS Goat RSSS Collection Worksheet Circle IC Document
VSLS Goat RSSS_Collection_worksheet_Circle choice.pdf VSLS Goat RSSS Collection Worksheet Circle IC Document
VSLS sheep RSSS_Collection_worksheet_Fill in.pdf VSLS Sheep RSSS Collection Worksheet Fill-in IC Document
VSLS sheep RSSS_Collection_worksheet_Fill in.pdf VSLS Sheep RSSS Collection Worksheet Fill-in IC Document
VSLS Sheep RSSS_Collection_worksheet_Circle choice.pdf VSLS Sheep RSSS Collection Worksheet Circle IC Document
VSLS Sheep RSSS_Collection_worksheet_Circle choice.pdf VSLS Sheep RSSS Collection Worksheet Circle IC Document
Appendix C-E Screen Shots SCS-SCR VSLS AIMS_Redacted.pdf Appdx C thru E VSLS AIMS Screenshots IC Document
Appendix C-E Screen Shots SCS-SCR VSLS AIMS_Redacted.pdf Appdx C thru E VSLS AIMS Screenshots IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State, Local, or Tribal 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 54.2-54.21 and 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 5-19	FLOCK INSPECTION AND EPIDEMIOLOGY REPORT	VS 5-19 DEC 2011.pdf		No		Paper Only
Form	VS 5-19 D	Scrapie Epidemiology Report	VS 5-19D Feb 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	VS 1-23 AUG 2018.pdf		No		Paper Only
Form	VS 1-23 A	Indemnity Worksheet - Owner/Company	VS 1-23A-work May 2009.doc		No		Paper Only
Form	VS 5-19C	Scrapie PEMMP Inspection Report	VS 5-19C Feb 2011.pdf		No		Paper Only
Form	VS 5-29	Cooperative State - Scrapie Control Program	NSC - VS 5-29 JAN 2025-ICR-FIL-508 (20240701).pdf		No		Fillable Printable
Form	Vs 5-29A	Scrapie Test Record - Continuation Sheet	NSC - VS 5-29A JAN 2025-ICR-FIL-508.pdf		No		Fillable Printable
Form	VS 10-4	Specimen Submission	VS 10-4 FEB 2021 SEC.pdf	http://www.aphis.usda.gov/library/forms/pdf/VS_Form10_4.pdf	Yes	No	Printable Only
Form	Vs 5-19A	Flock Inspection and Epidemiology Report Initial Flcok Inspection for Complete Monitored Status in Scrapie Flock Certification Program	VS 5-19A June 2013 Final.pdf	https://www.aphis.usda.gov/library/forms/pdf/VS_5_19A.pdf	Yes	No	Printable Only
Form	Vs 5-19b	Flock Inspection and Epidemiology Report Flock Inspection for Complete Monitored Status in the Scrapie Flock Certification Program	VS 5-19B June 2013 Final.pdf	https://www.aphis.usda.gov/library/forms/pdf/VS_5_19B.pdf	Yes	No	Printable Only
Form	VS 5-24	Application for Scrapie Classification, Classification Renewal, or Reclassification of a State	VS 5-24 (AUG 2010)(SECURE).pdf		No		Paper Only
Form	VS 5-18A	RECORD OF ANIMALS ACQUIRED	VS 5-18A Dec 2011.pdf	https://www.aphis.usda.gov/library/forms/pdf/VS_5_18A.pdf	Yes	No	Printable Only
Form	VS 1-27	PERMIT FOR MOVEMENT OF RESTRICTED ANIMALS	VS 1-27 JUL 2011.doc	http://www.aphis.usda.gov/library/forms	Yes	No	Printable Only
Form	VS 17-140	UNITED STATES ORIGIN HEALTH CERTIFICATE	VS 17-140 AUG 2018.pdf	http://www.aphis.usda.gov/library/forms	Yes	No	Printable Only
Form	VS 10-4A	Continuation Sheet for Specimen Submission	VS 10-4A AUG 2009 (20200629) Secure.pdf		Yes	No	Fillable Printable

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: 68	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Previously Approved
Annual Number of Responses for this IC	18,989	18,989
Annual IC Time Burden (Hours)	17,951	17,951
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
FY23 Grant and Coop Agreement Guide	FY23 VS Grant and Cooperative Agreements Recipient Guide.pdf	10/10/2023
MOU Template	MOU template.docx	10/10/2023
On-Farm Worksheet	On-farm_worksheet.pdf	10/10/2023
VSLS Goat RSSS Collection Worksheet Fill-in	VSLS Goat RSSS_Collection_worksheet_Fill in.pdf	10/10/2023
VSLS Goat RSSS Collection Worksheet Circle	VSLS Goat RSSS_Collection_worksheet_Circle choice.pdf	10/10/2023
VSLS Sheep RSSS Collection Worksheet Fill-in	VSLS sheep RSSS_Collection_worksheet_Fill in.pdf	10/10/2023
VSLS Sheep RSSS Collection Worksheet Circle	VSLS Sheep RSSS_Collection_worksheet_Circle choice.pdf	10/10/2023
Appdx C thru E VSLS AIMS Screenshots	Appendix C-E Screen Shots SCS-SCR VSLS AIMS_Redacted.pdf	10/10/2023

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