Information Collection

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

IC 217505 under ICR 201712-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
REPORTING THE IDENTIFICATION OF A SELECT AGENT OR TOXIN FROM A CLINICAL/DIAGNOSTIC SPECIMEN (APHIS/CDC FORM 4A) Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen	Form
Form APHIS/CDC FORM 4A Reporting the Identification of a Select Agent or Toxin form a Clinical/Diagnostic Specimen Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen	Form and Instruction
REPORTING THE IDENTIFICATION OF A SELECT AGENT OR TOXIN Att7a-Form4A.PDF	Form
APHIS/CDC FORM 4A Reporting the Identification of a Select Agent or Toxin Att4A-Rept the ID of Select Agent from Clinical Specime....pdf www.selectagents.gov/form4.html	Form and Instruction
Att4a - Form4-SATRN Screenprints.docx APHIS/CDC FORM 4, (screenshots)	IC Document

IC Title:

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

Agency IC Tracking Number:

0920-0576 18FL

Is this a Common Form? No

IC Status: Modified

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	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

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: 1,030

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

Documents for IC

table that charts IC Documents
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.