OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen (Form 4)

IC 217505 under ICR 202203-0920-007 · OMB 0920-0576.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen (Form 4) 0920-0576 18FL
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 4A Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen APHIS-CDC_Form_4-clean version.docx 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

1,181 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved 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 1,181 0 0 0 0 1,181
Annual IC Time Burden (Hours) 1,181 0 0 0 0 1,181
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Minor Changes to Form 4 (March 2022) APHIS-CDC_Form_4-tracked changes.docx 03/21/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.