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Select Agent Registration (State, Local & Tribal)
Select Agent Registration
OMB: 0579-0213
IC ID: 186793
OMB.report
USDA/APHIS
OMB 0579-0213
ICR 201305-0579-007
IC 186793
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0579-0213 can be found here:
2022-06-15 - Extension without change of a currently approved collection
2019-06-12 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Form APHIS/CDC Form 1 (
Select Agent Registration (State, Local & Tribal)
Form and Instruction
REVISED Guidance Document for the Completion of APHIS-CDC Form 2 FINAL.doc
www.selectagents.gov
Instruction
Form 4 Guidance Document.doc
www.selectagents.gov
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
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
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
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 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 4C Reporting the Identification of a Select Agent or Toxin:
APHIS-CDC Form 4C FederalLaw Revised.doc
www.selectagents.gov
Form and Instruction
APHIS/CDC Form 1 ( Application for Registration for Possession, Use, and Tr
APHIS-CDC Form 1 (Revised).docx
www.selectagents.gov
Form and Instruction
APHIS/CDC Form 2 Request to Transfer Select Agents and Toxins
APHIS-CDC Form 2 Request to Transfer Select Agents and Toxins.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 Notification of Theft, Loss or Release.docx
www.selectagents.gov
Form and Instruction
APHIS/CDC Form 5 Request for Exemption of Select Agents and Toxins for Pu
APHIS-CDC Form 5.doc
www.selectagents.gov
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Select Agent Registration (State, Local & Tribal)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection 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 (Revised)
Application for Registration for Possession, Use, and Transfer of Select Agents and Toxins
APHIS-CDC Form 1 (Revised).docx
http://www.selectagents.gov
Yes
Yes
Fillable Fileable
Instruction
REVISED Guidance Document for the Completion of APHIS-CDC Form 2 FINAL.doc
http://www.selectagents.gov
Yes
Yes
Fillable Printable
Form and Instruction
APHIS/CDC Form 2
Request to Transfer Select Agents and Toxins
APHIS-CDC Form 2 Request to Transfer Select Agents and Toxins.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 Notification of Theft, Loss or Release.docx
http://www.selectagents.gov
Yes
Yes
Fillable Fileable
Instruction
Form 4 Guidance Document.doc
http://www.selectagents.gov
Yes
Yes
Fillable Printable
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.doc
http://www.selectagents.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
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
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 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 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 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:
163
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
75 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,559
0
0
0
0
1,559
Annual IC Time Burden (Hours)
4,760
0
0
0
0
4,760
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.