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Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen

IC 217505 under ICR 201712-0920-006 · OMB 0920-0576.

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Form
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Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen 0920-0576 18FL
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA REPORTING THE IDENTIFICATION OF A SELECT AGENT OR TOXIN FROM A CLINICAL/DIAGNOSTIC SPECIMEN (APHIS/CDC FORM 4A) Att7a-Form4A.PDF NA Yes Yes Fillable Fileable
Form and Instruction APHIS/CDC FORM 4A Reporting the Identification of a Select Agent or Toxin form a Clinical/Diagnostic Specimen Att4A-Rept the ID of Select Agent from Clinical Specime....pdf http://www.selectagents.gov/form4.html Yes Yes Fillable Fileable

Health Illness Prevention

09-20-0170 National Select Agent Registry/Select Agent Transfer and Entity Registration Information System   76 FR 4483

1,030 0
   
State, Local, and Tribal Governments
 
   100 %

  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 1,030 0 0 0 0 1,030
Annual IC Time Burden (Hours) 515 0 0 0 0 515
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
APHIS/CDC FORM 4, (screenshots) Att4a - Form4-SATRN Screenprints.docx 12/18/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.