Form CDC 75.10 CDC 75.10 Application for Registration as an Importer of Nonhuman

DEPARTMENT OF HEALTH & HUMAN SERVICES PUBLIC HEALTH SERVICE
CENTERS FOR DISEASE CONTROL AND PREVENTION NATIONAL CENTER FOR
PREVENTION SERVICES DIVISION OF QUARANTINE (EO3)
ATLANTA, GEORGIA 30333

Form Approved
OMB No. 0920-0263
Expiration Date: 8/31/2020

Application For Registration as an Importer of Nonhuman Primates*
Organizational Name:

Telephone No.:

Address:
Person Responsible for Required Record Keeping and Reporting:

1. Estimated number of nonhuman primates to be imported or to be received
within 31 days of importation in the period covered by this registration:

2. If currently registered, number of nonhuman primates imported or
received within 31 days of importation in the previous 2-year period*

3. Animal Holding Facilities:
a. Attach sketch of facility indicating rooms or area where newly acquired nonhuman primates are held and the relationship of these rooms or areas
to offices, laboratories and other animal rooms in the same building.
b. Air handling procedures in rooms or areas where newly acquired primates are held:
(1) Air pressure in holding rooms
is higher than
same as
lower than
(2) Is exhaust air filtered?

Yes No

adjacent corridors and other immediately adjoining areas.

If yes, specify the type of filtration:

c. Usual number of animals per cage in the quarantine area:
Prosimians:

Old World Species:

New World Species:

Great Apes:

d. Waste disposal procedures for animal feces

For dead animals:

4. Have you developed standard operating procedures for:
a. Animal transport to
your facility

Yes No

b. Intake procedures for
arriving animals

Yes No

c. Animal husbandry

Yes No

d. Laundry

Yes No

e. Worker protection/use of
personal protective equipment

Yes No

f. Necropsy

Yes No

g. Considerations for
B virus exposures

Yes No

h. Statement of intended use

Yes No

i. Communication with CDC

Yes No

j. TB testing of NHPs in quarantine

Yes

No

5. Are newly acquired nonhuman primates held in rooms or areas with dedicated air-handling systems? Yes No
6. Are all animals that died during the quarantine period necropsied?

Yes No

7. Is entry to the area where newly acquired nonhuman primates are held restricted to only those personnel who are essential to its operation?
Yes No
8. Is a veterinarian retained to provide or supervise care of nonhuman primates?
Name:
Address:

CDC 75.10 July 2020 CS317582-A

Yes No
Telephone No.:

9. Personnel Health Program
a. Are all employees given a pre-employment tuberculin test?

Yes No

b. Routine interval between tuberculin tests of employees after employment:
Number of months:

or

Not Done

c. Do you have a respiratory control program, as required by OSHA 29 CFR 1910.134 Respiratory Protection - Standards?
d. Are workers fit-tested and trained annually?

Yes No

e. Is an occupational health clinic or physician retained to supervise health care programs?
Name:

Yes No

Yes No
Telephone No.:

Address:

10. Assurance Statement
As a condition of registration I, (we) assure the Director, Centers for Disease Control and Prevention that I (we) will import live nonhuman primates into the
United States only for bona fide scientific, educational, or exhibition purposes. I (we) shall not subsequently sell, resell, or otherwise distribute the nonhuman
primates to any other person or organization without clear evidence that these animals will be used solely for bona fide scientific, educational, or exhibition
purposes. I (we) understand that “nonhuman primates” are defined as all nonhuman primates of the Order Primates including but not limited to animals
commonly known as monkeys, chimpanzees, orangutans, gorillas, gibbons, apes, baboons, marmosets, tamarins, lemurs, and lorises.
11. Signature of Person Completing this Form: Date:

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS
D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0263.

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CDC 75.10 July 2020 CS317582-A

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