Incident Form to Report Potential Theft, Loss, Release, or Occpational Exposure

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

OMB: 0920-0576

IC ID: 217520

Information Collection (IC) Details

View Information Collection (IC)

Incident Form to Report Potential Theft, Loss, Release, or Occpational Exposure 0920-0576
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction APHIS/CDC FORM 3 INCIDENT FORM TO REPORT POTENTIAL THEFT, LOSS, RELEASE, OR OCCUPATIONAL EXPOSURE Att19 - Notification of Theft Loss or Releasev1.docx http://www.selectagents.gov/form3.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

201 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 201 0 -4 0 0 205
Annual IC Time Burden (Hours) 201 0 -107 0 0 308
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Drop down list APHIS-CDC_Form_3_English_Fillable.pdf 12/01/2016
APHIS/CDC Form 3,(screenshots) Att3a - Form3-SATRN Screenprints.docx 12/18/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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