Form 0920-0576 Amendment to Registration

This application is: ____________________________

Date

Entity name:

Entity registration number (e.g., A00000000-0000):

SECTION 6 – BIOSAFETY AND LABORATORY INFORMATION ON SELECT AGENTS AND TOXINS

Make additional copies of this section of the form as needed for each PI at your entity. Each PI should complete the appropriate section for

laboratories under his/her control where select agents are used or stored. For information on completing this section, refer to page 3 (B)(7) of the

guidance document.

SECTION 6A – TO BE COMPLETED BY ALL ENTITIES FOR EACH PRINCIPAL INVESTIGATOR

Provide the following information on a separate line for each laboratory safety level: the select agent or toxin; the strain designation of the select

agent or toxin, the building and room number(s) where each select agent or toxin will be used and stored, and laboratory safety level for each PI (or

Chief Scientist). For entities only storing and not actively working with select agents or toxins, do not complete “laboratory area” column. For

information on completing this section, refer to page 3 (B)(7) of the guidance document.

Select Agent/Toxin

Strain Designation (list “N/A” if not applicable or “TBA” if to be acquired)

Laboratory Area

Storage Area

Laboratory Safety Level*

Principal Investigator

Bldg

Room

Bldg

Room

*Biosafety Level 2=BSL2 Animal Biosafety Level 2=ABSL2 rDNA BSL2=NIHBL2 rDNA Large Animal BSL2=NIH BL2N rDNA Large Scale BSL2=NIH BL2-LS

Biosafety Level 3=BSL3 Animal Biosafety Level 3=ABSL3 rDNA BSL3=NIHBL3 rDNA Large Animal BSL3=NIH BL3N rDNA Large Scale BSL3=NIH BL3-LS

Biosafety Level 4=BSL4 Animal Biosafety Level 4=ABSL4 rDNA BSL4=NIHBL4 rDNA Large Animal BSL4=NIH BL4N rDNA Large Scale BSL4=NIH BL4-LS

Plant=BSL2 Plant=BSL3 Biosafety Level 3 Agriculture=BSL3ag Toxin= 29 CFR 1910.1450, 29 CFR 1910.1200 and BMBL