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INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
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| Select Agent Registration |
0579-0213 |
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| DATE PREPARED |
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| December 6, 2011 |
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
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|
|
REPORTS |
RECORDS |
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TOTAL |
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|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
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|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
| 121.10, 331.10 |
Request for Expedited Access Approval Review (business) |
Letter |
2 |
1.00 |
2.00 |
3.00 |
6.00 |
|
|
0.00 |
|
(State and local government) |
|
1 |
1.00 |
1.00 |
3.00 |
3.00 |
|
|
0.00 |
| 121.7, 331.7 |
Application for Registration for Possession, Use and Transfer of Select Agents and Toxins (business) + (not-for-profit) |
APHIS/CDC 1 |
7 |
1.00 |
7.00 |
3.75 |
26.25 |
|
|
0.00 |
|
(State and local government) |
|
9 |
1.00 |
9.00 |
1.00 |
9.00 |
|
|
0.00 |
| 121.16, 331.16 |
Request to Transfer Select Agents and Toxins (business) + (not-for-profit) |
APHIS/CDC 2 |
25 |
1.00 |
25.00 |
1.50 |
37.50 |
|
|
0.00 |
|
(State and local government) |
|
28 |
1.00 |
28.00 |
1.50 |
42.00 |
|
|
0.00 |
| 121.16 |
Report of Transfer of Proficiency Test (business) + (not-for-profit) |
None |
2 |
1.00 |
2.00 |
1.00 |
2.00 |
|
|
0.00 |
|
(State and local government) |
|
1 |
1.00 |
1.00 |
1.00 |
1.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
75.00 |
|
126.75 |
0.00 |
|
0.00 |
|
TOTAL OF ALL PAGES |
|
|
|
1,163.00 |
|
2,289.41 |
1.00 |
|
1.00 |
| TOTAL - COLUMNS "F" AND "I" = OMB 831, 13 b; COLUMNS "H" AND "K" = OMB 831, 13c |
|
|
|
1,164.00 |
|
2,290.41 |
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INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
| Select Agent Registration |
0579- 0213 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
|
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
| 121.19, 331.19 |
Report of Theft, Loss, or Release of Select Agent and Toxins (business) + (not-for-profit) |
APHIS/CDC 3 |
5 |
1.00 |
5.00 |
1.00 |
5.00 |
|
|
0.00 |
|
(State and local government) |
|
10 |
1.00 |
10.00 |
1.00 |
10.00 |
|
|
0.00 |
| 121.4.5.6.9, 331.5, 9 |
Reporting the Identification of a Select Agent or Toxin in a Clinical/Diagnostic Specimen (business) + (not-for-profit) |
APHIS/CDC 4 A, B, and C |
2 |
1.00 |
2.00 |
1.00 |
2.00 |
|
|
0.00 |
|
(State and local government) |
|
24 |
1.00 |
24.00 |
1.00 |
24.00 |
|
|
0.00 |
| 121.5, 331.5 |
Request for Exemption of Select Agents and Toxins for Public Health or Agricultural Emergency or Investigational Product (business) + (not-for-profit) |
APHIS CDC/5 |
2 |
1.00 |
2.00 |
1.00 |
2.00 |
|
|
0.00 |
|
(State and local government) |
|
1 |
1.00 |
1.00 |
1.00 |
1.00 |
|
|
0.00 |
| 121.8, 331.17 |
Appeal of Registration Denial, Surrender of Registration Certificate (business) + (not-for-profit) |
Letter |
2 |
1.00 |
2.00 |
1.00 |
2.00 |
|
|
0.00 |
|
(State and local government) |
|
1 |
1.00 |
1.00 |
1.00 |
1.00 |
|
|
0.00 |
| 121.9, 331.9 |
Request of ID Select Agents or Toxins Contained in Specimens Presented for Diagnosis or Verification (business)+ (not-for-profit) |
Letter |
2 |
1.00 |
2.00 |
1.00 |
2.00 |
|
|
0.00 |
|
(State and local government) |
|
1 |
1.00 |
1.00 |
1.00 |
1.00 |
|
|
0.00 |
|
SUBTOTAL |
|
|
|
50.00 |
|
50.00 |
1 |
|
0.00 |
|
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|
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|
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|
INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
|
TITLE OF INFORMATION COLLECTION DOCUMENT |
OMB NO. |
|
|
|
|
|
|
|
|
| Select Agent Registration |
0579- 0213 |
|
|
|
|
|
| DATE PREPARED |
|
|
|
| November 30, 2010 |
| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
|
ANNUAL BURDEN |
|
|
|
|
|
|
|
|
REPORTS |
RECORDS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL |
|
|
|
|
|
|
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
RECORD- |
| SECTION OF |
DESCRIPTION |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
RECORD- |
HOURS PER |
KEEPING HOURS |
| REGS. |
|
|
|
|
|
so state) |
|
PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
KEEPERS |
RECORD- |
(Col. I x J) |
|
|
|
|
|
|
|
|
RESPONDENT |
|
|
|
|
KEEPER |
|
| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
(I) |
(J) |
(K) |
| 121.9, 331.9 |
Report of ID or Select Agents or Toxins Contained in Specimens Presented for Proficency Testing (business) + (not-for-profit) |
Letter |
2 |
1.00 |
2.00 |
1.00 |
2.00 |
|
|
0.00 |
|
(State and local government) |
|
1 |
1.00 |
1.00 |
1.00 |
1.00 |
|
|
0.00 |
| 121.17, 331.17 |
Recordkeeping (business) |
None |
|
|
0.00 |
|
0.00 |
1 |
0.500 |
1.00 |
| 121.18, 331.18 |
Inspection of Facilities (business) + (not-for-profit) |
None |
33 |
cbsickles:
1.00 |
33.00 |
8.00 |
264.00 |
|
|
0.00 |
|
(State and local government) |
None |
42 |
1.00 |
42.00 |
8.00 |
336.00 |
|
|
0.00 |
| 121.6 |
Application for Permit to Import or Transport Controlled Material or Organisms or Vectors (business) |
VS 16-3 |
941 |
1.00 |
941.00 |
1.60 |
1,505.60 |
|
|
0.00 |
| 121.16 |
Additional Information for Cell Cultures and their Products (business) |
VS 16-7 |
1 |
1.00 |
1.00 |
0.33 |
1.00 |
|
|
0.00 |
| 331.16 |
Application and Permit to Move Live Plants or Noxious Weeds (business) |
PPQ 526 |
18 |
1.00 |
18.00 |
0.17 |
3.06 |
|
|
|
|
SUBTOTAL |
|
|
|
1,038.00 |
|
2,112.66 |
1 |
|
1.00 |