VS 16-7 Additional Information for Cell Cultures and Their Produ

Select Agent Registration

VS 16-7 Dec 2011

Select Agent Registration

OMB: 0579-0213

Document [pdf]
Download: pdf | pdf
Failure to supply all applicable information can delay the processing of this application.

PLEASE TYPE OR PRINT CLEARLY.

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 numbers for these information collections are 0579-0094 and 0579-0213. The time required to complete
this information collection is estimated to average 0.17 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.
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

OMB APPROVED
0579-0094 and 0579-0213
EXP DATE XX//XXXX

ADDITIONAL INFORMATION FOR CELL CULTURES AND THEIR PRODUCTS
(Monoclonal Antibodies, Recombinant Products, Extracts, Viruses, etc.)
(Supplement to VS Form 16-3)
1. SPECIES AND TISSUE OF ORIGIN OF CELL LINE(S). ALSO, INCLUDE COUNTRY OF ORIGIN

2. IMMUNOGEN (for monoclonal antibodies and hybridomas)

3. REFERENCE NUMBER OF CELL LINE(S)

4. IDENTIFY ALL ANIMAL DERIVED NUTRITIVE FACTORS IN THE MEDIA (e.g., serum, albumin, transferrin, trypsin, etc.). IDENTIFY THE
COUNTRY OF ORIGIN AND SPECIES OF ORIGIN OF ALL NUTRITIVE FACTORS.

5. IDENTIFY ANY ANIMAL PATHOGENS THAT ARE STUDIED IN THE LAB WHERE THE CELL LINE ORIGINATES. ALSO NAME ANY ANIMAL
PATHOGENS INFECTING THE CELL LINE.

6. IF THE CELL LINE IS RECOMBINANT, SPECIFY GENETIC INSERT (do not use abbreviations)

7. POTENTIAL USE OF IMPORTED CELLS OR PRODUCTS (use of derivatives or extracts, immunogen for antibodies produced, and production
method. If for animal use, specify the animal species.)

8. SIGNATURE

VS FORM 16-7
DEC 2011

9. DATE


File Typeapplication/pdf
File TitleFailure to supply all applicable information can delay the processing of this application
Authorkahardy
File Modified2011-12-06
File Created2011-12-06

© 2024 OMB.report | Privacy Policy