NAHMS-450 2019 NAHMS Goat Study Consent Form

National Animal Health Monitoring System

2150 Centre Ave, Bldg B

Fort Collins, CO 80526

Form Approved

OMB Number 0579-0354

Expires:

N ATIONAL AGRICULTURAL STATISTICS SERVICE

Animal and Plant Health

Inspection Service

Veterinary Services

201 9 NAH MS GOAT STUDY CONSENT FORM

For release of information for: NOTES:

EPAID:

(Consenting Operator: Hereafter referred to as YOU)

The USDA’s Animal and Plant Health Inspection Service’s (APHIS) National Animal Health Monitoring System (NAHMS) is conducting a study of U.S. goat operations. NAHMS studies are voluntary and nonregulatory. This study will take an in-depth look at U.S. goat operations and provide new and valuable information regarding animal health and management practices in the U.S. goat industry. To initiate the study, a sample was selected from the confidential list of operations maintained by USDA’s National Agricultural Statistics Service (NASS). Your operation was selected for participation and will represent a number of unselected goat operations.

By signing this Consent Form, you are agreeing to allow USDA–NASS staff to provide the following information to the State NAHMS Coordinator, who is employed by USDA–APHIS: your name, address, phone number, email address, total inventory, and operation type (meat/dairy/other).

The NAHMS Coordinator will share this information with a Federal or State veterinary medical officer (VMO), who will contact you to administer a phase II questionnaire. You will also have the opportunity to obtain free testing for your goats, including testing for: parasites both pre- and post-deworming, Scrapie resistant genotypes, Mycoplasma ovipneumonia, and fecal pathogens. Only the Federal or State VMOs collecting the data know the identity of study participants.

Confidentiality of your data is crucially important to us. No name or contact information will be associated with individual data, and no data will be reported in a way that could reveal the identity of a participant. Data are presented only in aggregated summaries.

When you are contacted by a Federal or State VMO and asked to participate in the study, you are free to accept or decline participation at that time. A copy of the questionnaire that will be administered when you’re visited by the Federal or State VMO can be found at: www.aphis.usda.gov/nahms. If you have been selected but have not been contacted or if you have questions regarding the study, please call: (866) 907-8190.

1. Number of goats on the operation as of July 1, 2019: _____ head

2. Operation Address: _____________________________________________ 3. Operation phone #: _________________

4. Operation Email Address: ____________________________________________________________________________

4. Meat

   Dairy

   Fiber

   Agritourism

   Other

   Use of goats on operation (check all that apply):

4. Notes regarding the operation, (e.g. animals located in different state, changes to address or contact information):

Consenting Operator SIGN DATE

NASDA/NASS Staff SIGN DATE

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0354. The time required to complete this information collection is estimated to average .15 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0004. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0004. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.