Possession, Use, and Transfer of Select Agents and Toxins (42 CFR 73)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Inventory of Select Agents Guidance	Form and Instruction	Unchanged	Available
Training Guidance	Form and Instruction	Unchanged	Available
Incident Response Plan Template	Form and Instruction	Unchanged	Available
Incident Response Plan Guidance	Form and Instruction	Unchanged	Available
Request Regarding a Restricted Experiment Guidance	Form and Instruction	Unchanged	Available
BioSafety Plan Template	Form and Instruction	Unchanged	Available
BioiSafety Plan Guidance	Form and Instruction	Unchanged	Available
Security Plan Template	Form and Instruction	Unchanged	Available
Security Plan - Guidance	Form and Instruction	Unchanged	Repair queued
Request for Exclusion - Guidance	Form and Instruction	Unchanged	Available
Request for Exemption of Select Agent and Toxin for an Investigational Product (APHIS/CDC Form 5) - Guidance	Form and Instruction	Unchanged	Available
Form 0920-0576 Report of Identification of a Select Agent or Toxin (APHIS/CDC Form 4) - Guidance	Form and Instruction	Unchanged	Available
Form APHIS/CDC FORM 4C Att 4C_Federal Law Enforcement Reporting Seizure of Select Agent of Toxin (APHIS/CDC) Form 4C	Form and Instruction	Unchanged	Available
Report of Theft, Loss or Release of Select Agent or Toxin (APHIS/CDC Form 3) - Guidance	Form and Instruction	Unchanged	Repair queued
Request to Transfer Select Agents and Toxins (APHIS/CDC Form 2) - Guidance	Form and Instruction	Unchanged	Available
Application for Registration (APHIS/CDC Form 1) - Guidance	Form and Instruction	Unchanged	Available
Form APHIS/CDC FORM 4B Report of Identification of a Select Agent or Toxin from a Proficiency Test	Form and Instruction	Unchanged	Available
Administrative Review	Form	Unchanged	Available
Form APHIS/CDC FORM 3 Incident Form to Report Potential Theft, Loss, Release, or Occpational Exposure	Form and Instruction	Unchanged	Available
Records	Form	Unchanged	Repair queued
Form APHIS/CDC FORM 2 Request to Transfer Select Agents and Toxins (APHIS/CDC Form 2)	Form and Instruction	Unchanged	Available
Training	Form	Unchanged	Available
Incident Response Plan	Form	Unchanged	Available
Request Regarding a Restricted Experiment	Form	Unchanged	Available
Biosafety Plan	Form	Unchanged	Available
Security Plan	Form	Unchanged	Repair queued
Request for Expedited Review	Form	Unchanged	Repair queued
Documentation of Self-Inspection	Form	Unchanged	Available
Amendment to a Certificate of Registration	Form	Unchanged	Available
Application for Registration (APHIS/CDC Form 1)	Form	Unchanged	Available
Request for Exemption of Select Agent Agent and Toxin for an Investigational Product (APHIS/CDC Form 5)	Form	Unchanged	Available
Form 0920-0576 Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen	Form and Instruction	Unchanged	Available
Request for Exclusions	Form	Unchanged	Available
Attachment 1 - SATRN Screenprints_2017-09-18.docx	Supplementary Document	Uploaded 2018-10-19	Available
Non-substantive change request-180812.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-10-19	Available
APHIS-CDC Form 4A 0920-0576_2018-08-08.docx	Supplementary Document	Uploaded 2018-10-19	Repair queued
APHIS-CDC Form 4A (revised) 0920-0576_2018-08-08.docx	Supplementary Document	Uploaded 2018-10-19	Available
0920-0576-Non-substantive change request 27APR2018.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-04-27	Available
Att6 - SORN-EFSAP.DOC	Supplementary Document	Uploaded 2017-12-18	Available
Att5 - SORN-NSAR.PDF	Supplementary Document	Uploaded 2017-12-18	Available
NonSubChangeRequest.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-12-18	Available
Att2a-60-DayComments.pdf	Supplementary Document	Uploaded 2017-08-03	Available
Att2-60-Day.pdf	Supplementary Document	Uploaded 2017-08-03	Available
0920-0576-SSB 06JUL2017.DOCX	Supporting Statement B	Uploaded 2017-08-03	Available
0920-0576 SSA 06JUL2017.doc	Supporting Statement A	Uploaded 2017-08-03	Available
Attachment 4 - System of Record Notice.PDF	Supplementary Document	Uploaded 2015-07-16	Available
Attachment 1 - CDC Select Agent Regulations.pdf	Supplementary Document	Uploaded 2015-07-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227819	Inventory of Select Agents Guidance	Form and Instruction	Unchanged
227818	Training Guidance	Form and Instruction	Unchanged
227817	Incident Response Plan Template	Form and Instruction	Unchanged
227816	Incident Response Plan Guidance	Form and Instruction	Unchanged
227815	Request Regarding a Restricted Experiment Guidance	Form and Instruction	Unchanged
227814	BioSafety Plan Template	Form and Instruction	Unchanged
227813	BioiSafety Plan Guidance	Form and Instruction	Unchanged
227811	Security Plan Template	Form and Instruction	Unchanged
227809	Security Plan - Guidance	Form and Instruction	Unchanged
227807	Request for Exclusion - Guidance	Form and Instruction	Unchanged
227806	Request for Exemption of Select Agent and Toxin for an Investigational Product (APHIS/CDC Form 5) - Guidance	Form and Instruction	Unchanged
227783	Report of Identification of a Select Agent or Toxin (APHIS/CDC Form 4) - Guidance	Form and Instruction	Unchanged
227782	Att 4C_Federal Law Enforcement Reporting Seizure of Select Agent of Toxin (APHIS/CDC) Form 4C	Form and Instruction	Unchanged
227779	Report of Theft, Loss or Release of Select Agent or Toxin (APHIS/CDC Form 3) - Guidance	Form and Instruction	Unchanged
227769	Request to Transfer Select Agents and Toxins (APHIS/CDC Form 2) - Guidance	Form and Instruction	Unchanged
227767	Application for Registration (APHIS/CDC Form 1) - Guidance	Form and Instruction	Unchanged
227499	Report of Identification of a Select Agent or Toxin from a Proficiency Test	Form and Instruction	Unchanged
217521	Administrative Review	Form	Unchanged
217520	Incident Form to Report Potential Theft, Loss, Release, or Occpational Exposure	Form and Instruction	Unchanged
217519	Records	Form	Unchanged
217518	Request to Transfer Select Agents and Toxins (APHIS/CDC Form 2)	Form and Instruction	Unchanged
217517	Training	Form	Unchanged
217516	Incident Response Plan	Form	Unchanged
217515	Request Regarding a Restricted Experiment	Form	Unchanged
217514	Biosafety Plan	Form	Unchanged
217512	Security Plan	Form	Unchanged
217511	Request for Expedited Review	Form	Unchanged
217510	Documentation of Self-Inspection	Form	Unchanged
217509	Amendment to a Certificate of Registration	Form	Unchanged
217508	Application for Registration (APHIS/CDC Form 1)	Form	Unchanged
217507	Request for Exemption of Select Agent Agent and Toxin for an Investigational Product (APHIS/CDC Form 5)	Form	Unchanged
217505	Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen	Form and Instruction	Unchanged
217504	Request for Exclusions	Form	Unchanged

ICR Details

OMB Control No: 0920-0576	ICR Reference No: 201810-0920-006
Status: Historical Inactive	Previous ICR Reference No: 201804-0920-015
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0576 18AXH
Title: Possession, Use, and Transfer of Select Agents and Toxins (42 CFR 73)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 10/24/2018
	Date Received in OIRA: 10/23/2018
Terms of Clearance: CDC may resubmit the change request after the relevant SORN(s) have been updated.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	10/31/2020	01/31/2021
Responses	7,869	0	7,869
Time Burden (Hours)	8,347	0	8,347
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Disease Control and Prevention collects information under 42CFR Part 73, with the purpose of ensuring select agents or toxins are managed appropriately to prevent any threats to human health or safety. This Non-Substantive Change Request is to modify APHIS/CDC Form 4A to clarify the meaning/intent of the question for the select agent or toxin identified as Botulinum neurotoxins. The revised Form 4A will result in a decrease in 60 Burden Hours for regulated entities.

---

Authorizing Statute(s): PL: Pub.L. 107 - 188 Subtitle A Name of Law: Public Health Security and Bioterrorism Preparedness and Response Act of 2002
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 96456	12/30/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 36144	08/03/2017
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 33

table that charts list of burden

IC Title	Form No.	Form Name
Security Plan Template	NA	Security Plan Template
Application for Registration (APHIS/CDC Form 1) - Guidance	NA	Guidance Document for the completion of APHIS/CDC Form 1
Request for Exemption of Select Agent and Toxin for an Investigational Product (APHIS/CDC Form 5) - Guidance	NA	Guidance Document for the completion of APHIS/CDC Form 5
Request for Exclusion - Guidance	NA	Guidance Document for Exclusion of Select Agents and Toxins
Security Plan - Guidance	NA	Guidance Document for the completion of Security Plan
Report of Theft, Loss or Release of Select Agent or Toxin (APHIS/CDC Form 3) - Guidance	NA	Guidance Document for the completion of APHIS/CDC Form 3
Incident Response Plan Template	NA	Incident Response Plan Template
Training Guidance	NA	Guidance Document for the completion of Training
Request for Exclusions	none	Request for Exclusions
Report of Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen	0920-0576	APHIS/CDC FORM 4A - REPORTING THE IDENTIFICATION OF A SELECT AGENT OR TOXIN FROM A CLINICAL/DIAGNOSTIC SPECIMEN
Request for Exemption of Select Agent Agent and Toxin for an Investigational Product (APHIS/CDC Form 5)	none	Request for Exemption
Application for Registration (APHIS/CDC Form 1)	APHIS/CDC FORM 1, none	Application for Registration ,   Application for Registration for Possession, Use, and Transfer of Select Agents and Toxins
Amendment to a Certificate of Registration	none	Amendment to Registration
Security Plan	none	Secuity Plan
Biosafety Plan	none	Biosafety Plan
Training	none	Training
Records	none	Records
Incident Form to Report Potential Theft, Loss, Release, or Occpational Exposure	NA, APHIS/CDC FORM 3	INCIDENT FORM TO REPORT POTENTIAL THEFT, LOSS, RELEASE, OR OCCUPATIONAL EXPOSURE ,   Incident Notification and Reporting APHIS/CDC Form 3 (Theft/Loss/Release)
Administrative Review	none	Administrative Review
Documentation of Self-Inspection	none	Documentation of self-inspection
Request for Expedited Review	none	Request for Expedited Review
Request Regarding a Restricted Experiment	none	Request Regarding Restricted Experiment
Incident Response Plan	none	Incident Response Plan
Request to Transfer Select Agents and Toxins (APHIS/CDC Form 2)	APHIS/CDC FORM 2, none	REQUEST FOR TRANSFER SELECT AGENTS AND TOXINS ,   Request to Transfer Select Agents and Toxins
Report of Identification of a Select Agent or Toxin from a Proficiency Test	NA, APHIS/CDC FORM 4B	REPORTING THE IDENTIFICATION OF A SELECT AGENT OR TOXIN: PROFICIENCY TESTING REPORT ,   REPORTING THE IDENTIFICATION OF A SELECT AGENT OR TOXIN FROM A PROFICIENCY TEST (APHIS/CDC FORM 4B)
Att 4C_Federal Law Enforcement Reporting Seizure of Select Agent of Toxin (APHIS/CDC) Form 4C	NA, APHIS/CDC FORM 4C	Reporting the Identification of a Select Agent or Toxin: Federal Law Enforcement Seizure Report ,   Reporting the Identification of a Select Agent or Toxin: Federal Law Enforcement Seizure Report (APHIS/CDC Form 4C)
Report of Identification of a Select Agent or Toxin (APHIS/CDC Form 4) - Guidance	0920-0576	Guidance Document for the Completion of APHIS/CDC Form 4
Inventory of Select Agents Guidance	NA	Guidance document for the completion of Inventory Records of Select Agents
Incident Response Plan Guidance	NA	Guidance Document for the completion of Incident Response Plan
Request to Transfer Select Agents and Toxins (APHIS/CDC Form 2) - Guidance	NA	Guidance Document for the completion of APHIS/CDC Form 2
BioiSafety Plan Guidance	NA	Guidance Documnet for the completion of BioSafety Plan
BioSafety Plan Template	NA	BioSafety Plan Template
Request Regarding a Restricted Experiment Guidance	NA	Guidance Document for the completion of Restricted Experiment Request

---

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This Non-Substantive Change Request includes a revised Form 4A that will reduce 120 forms for approximately 8 entities, resulting in a reduction of 60 Burden Hours.

---

Annual Cost to Federal Government: $20,210,121

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/23/2018

---