Information Collection

Report of Identification of a Select Agent or Toxin

IC 217505 under ICR 201701-0920-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Report of Identification of a Select Agent or Toxin	Form
Report of Identification of a Select Agent or Toxin Attachment 6 - Report of Identification of a Select Agent or Toxin.docx	Form
APHIS-CDC_Form_4A_English_Fillable.pdf Drop down list	IC Document
APHIS-CDC_Form_4B_English_Fillable.pdf Drop down list	IC Document
APHIS-CDC_Form_4C_English_Fillable.pdf Drop down list	IC Document

IC Title:

Report of Identification of a Select Agent or Toxin

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Report of Identification of a Select Agent or Toxin	Attachment 6 - Report of Identification of a Select Agent or Toxin.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0170 National Select Agent Registry/Select Agent Transfer and Entity Registration Information System

FR Citation: 76 FR 4483

Number of Respondents: 303

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	909	909
Annual IC Time Burden (Hours)	909	909
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Drop down list	APHIS-CDC_Form_4A_English_Fillable.pdf	12/01/2016
Drop down list	APHIS-CDC_Form_4B_English_Fillable.pdf	12/01/2016
Drop down list	APHIS-CDC_Form_4C_English_Fillable.pdf	12/01/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.