State, Local, and Tribal Government

HPAI: Additional Testing and Reporting of HPAI in Livestock and Milk

Documents and Forms

Document Name Document Type
Form VS 12-1 State, Local, and Tribal Government Form and Instruction
VS 12-1 HPAI H5N1 Milk Submission Form VS 12-1 NOV 2024-ICR-FIL-508 XXXX.pdf Form and Instruction
VS 12-2 HPAI H5N1 Milk Silo Submission Form VS 12-2 DEC 2024-ICR-PRINT-508 XXXX.pdf Form and Instruction
VS 12-3 HPAI H5N1 Mandatory USDA Silo Monitoring Supply Order Fo VS 12-3 DEC 2024-ICR-PRINT-508 XXXX.pdf Form
NCAH Portal Screenshots.pdf NCAH Portal screenshots IC Document

Information Collection (IC) Details

IC Title:	State, Local, and Tribal Government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 NOV 2024-ICR-FIL-508 XXXX.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	VS 12-2	HPAI H5N1 Milk Silo Submission Form	VS 12-2 DEC 2024-ICR-PRINT-508 XXXX.pdf	Yes	Yes	Fillable Fileable
Form	VS 12-3	HPAI H5N1 Mandatory USDA Silo Monitoring Supply Order Form	VS 12-3 DEC 2024-ICR-PRINT-508 XXXX.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: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	12,860	2,100	10,760
Annual IC Time Burden (Hours)	8,455	1,950	6,505
Annual IC Cost Burden (Dollars)	0	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.