APHIS Form 79
APHIS FORM 79 2014.xls
Self - Certification Medical Statement
APHIS Form 79
OMB: 0579-0196
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0579-0196 can be found here:
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| APHIS-79: |
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5/14/2014 |
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Page 1 of 1 |
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Beverly Cassidy |
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0579-0196 |
| FORM NO. |
TOTAL ANNUAL RESPONDENT |
AVERAGE TIME PER RESPONDENT |
TOTAL HOURS PER YEAR |
GRADE & AVG RATE OF PROGRAM PERSONNEL (Avg rate=Hourly Wage) |
PROGRAM COSTS |
OVERHEAD COSTS (.139) |
TOTAL COSTS |
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| MRP Form 5 |
322 |
0.167 |
54 |
11 |
$33 |
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1782 |
247.7 |
2,029.70 |
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TOTAL |
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$1,782.00 |
$247.70 |
$2,029.70 |
| File Type | application/vnd.ms-excel |
| Author | cquatrano |
| Last Modified By | McDuffie, Cathy A - APHIS |
| File Modified | 2014-05-14 |
| File Created | 2002-09-24 |