Information Collection

Request for Exemption

IC 186024 under ICR 201507-0920-006 · OMB 0920-0576.

⚠️ Notice: This information collection may be referencing outdated material.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 10 Form 5 Request For Exemption.pdf Instruction
Attachment 18 Revised Form 5 Request for Exemption of Select Agent and Toxins.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Exemption	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 73:5&6 (d-e) 3&4 (e)(1) (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 10 Form 5 Request For Exemption.pdf		Yes	Yes	Fillable Printable
Instruction			Attachment 18 Revised Form 5 Request for Exemption of Select Agent and Toxins.doc		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: 3	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-3	3
Annual IC Time Burden (Hours)	-3	3
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.