Report of Identification of Select Agent or Toxin

Possession, Use, and Transfer of Select Agents and Toxins (42 CFR 73)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0576 can be found here:

Documents and Forms

Document Name Document Type
Attachment 9 Form 4A Report of Identification of Select Agent.pdf Instruction
Attachment 17 Revised Form 4A Report of Identification of Select Agent.docx Instruction

Information Collection (IC) Details

IC Title:	Report of Identification of Select Agent or Toxin	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 73(5)(6) 42 CFR 73.6 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 9 Form 4A Report of Identification of Select Agent.pdf		Yes	Yes	Fillable Printable
Instruction			Attachment 17 Revised Form 4A Report of Identification of Select Agent.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: National Select Agent Registry (NSAR) Select Agent Transfer and Entity Registration Information System (SATERIS), HHS/CDC/COPTER	FR Citation: 76 FR 4483

Number of Respondents: 320	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,880	2,880
Annual IC Time Burden (Hours)	2,880	2,880
Annual IC Cost Burden (Dollars)	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.