Information Collection

Select Agent Registration

IC 2397 under ICR 201110-0579-016 · OMB 0579-0213.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0213 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form APHIS-CDC Form 1 Select Agent Registration	Form and Instruction
APHIS-CDC Form 1 Application for Registration for Possession, Use, and Tr APHIS-CDC Form 1_9-08.doc www.selectagents.gov	Form and Instruction
APHIS-CDC Form 2 Request to Transfer Select Agents and Toxins APHIS-CDC Form 2_5-08.doc www.selectagents.gov	Form and Instruction
APHIS-CDC Form 3 Report of Theft, Loss, or Release of Select Agents and T APHIS-CDC Form 3_5-08.doc www.selectagent.gov	Form and Instruction
APHIS-CDC Form 4A Reporting the Identification of a Select Agent or Toxin APHIS-CDC Form 4A ReferenceLab_SampleProvider Revised.doc www.selectagent.gov	Form and Instruction
APHIS-CDC Form 5 Request For Exemption of Select Agents and Toxins for Pu APHIS-CDC Form 5_5-08.doc www.selectagent.gov	Form and Instruction
VS 16-3 Application for Permit to Import or Transport Controlled VS 16-3 Apr 2009.pdf www.aphis.usda.gov/library/forms/pdf/VS_16_3.pdf	Form
PPQ 526 Application and Permit to Move Live Plant Pests or Noxio PPQ 526 Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/PPQ_526.pdf	Form
VS 16-7 Additional Information for Cell Cultures and Their Produ VS 16-7 Dec 2011.pdf www.aphis.usda.gov/library/forms/pdf/VS_16_7.pdf	Form
APHIS-CDC Form 4B Reporting the Identification of a Select Agent or Toxin: APHIS-CDC Form 4B ProficiencyTest doc Revised.doc www.selectagents.gov	Form and Instruction
APHIS/CDC Form 4C Reporting the Identification of a Select Agent or Toxin: APHIS-CDC Form 4C FederalLaw Revised.doc www.selectagents.gov	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Select Agent Registration

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	APHIS-CDC Form 1	Application for Registration for Possession, Use, and Transfer of Select Agents and Toxins	APHIS-CDC Form 1_9-08.doc	http://www.selectagents.gov	Yes	Yes	Fillable Fileable
Form and Instruction	APHIS-CDC Form 2	Request to Transfer Select Agents and Toxins	APHIS-CDC Form 2_5-08.doc	http://www.selectagents.gov	Yes	Yes	Fillable Fileable
Form and Instruction	APHIS-CDC Form 3	Report of Theft, Loss, or Release of Select Agents and Toxins	APHIS-CDC Form 3_5-08.doc	http://www.selectagent.gov	Yes	Yes	Fillable Fileable
Form and Instruction	APHIS-CDC Form 4A	Reporting the Identification of a Select Agent or Toxin in a Clinical/Diagnostic Specimen	APHIS-CDC Form 4A ReferenceLab_SampleProvider Revised.doc	http://www.selectagent.gov	Yes	Yes	Fillable Fileable
Form and Instruction	APHIS-CDC Form 5	Request For Exemption of Select Agents and Toxins for Public Health or Agricultural Emergency or Investigational Product	APHIS-CDC Form 5_5-08.doc	http://www.selectagent.gov	Yes	Yes	Fillable Fileable
Form	VS 16-3	Application for Permit to Import or Transport Controlled Material or Organisms or Vectors	VS 16-3 Apr 2009.pdf	http://www.aphis.usda.gov/library/forms/pdf/VS_16_3.pdf	Yes	No	Fillable Printable
Form	PPQ 526	Application and Permit to Move Live Plant Pests or Noxious Weeds	PPQ 526 Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/PPQ_526.pdf	Yes	No	Fillable Printable
Form	VS 16-7	Additional Information for Cell Cultures and Their Products	VS 16-7 Dec 2011.pdf	http://www.aphis.usda.gov/library/forms/pdf/VS_16_7.pdf	Yes	No	Fillable Printable
Form and Instruction	APHIS-CDC Form 4B	Reporting the Identification of a Select Agent or Toxin: Proficiency Testing Report	APHIS-CDC Form 4B ProficiencyTest doc Revised.doc	http://www.selectagents.gov	Yes	Yes	Fillable Fileable
Form and Instruction	APHIS/CDC Form 4C	Reporting the Identification of a Select Agent or Toxin: Federal Law Enforcement Seizure Report	APHIS-CDC Form 4C FederalLaw Revised.doc	www.selectagents.gov	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Natural Resources

Subfunction: Agricultural Innovation and Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,044

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,045	401	644
Annual IC Time Burden (Hours)	1,861	786	1,075
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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