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

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0576 Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen Form and Instruction
0920-0576 APHIS/CDC FORM 4A - REPORTING THE IDENTIFICATION OF A SE APHIS-CDC Form 4 Report of Identification_2018-02-08_jw.docx Form and Instruction
Att4a - Form4-SATRN Screenprints.docx APHIS/CDC FORM 4, (screenshots) IC Document

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0576	APHIS/CDC FORM 4A - REPORTING THE IDENTIFICATION OF A SELECT AGENT OR TOXIN FROM A CLINICAL/DIAGNOSTIC SPECIMEN	APHIS-CDC Form 4 Report of Identification_2018-02-08_jw.docx	NA	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,030	0	1,030
Annual IC Time Burden (Hours)	455	-60	515
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.