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Federal forms, ICRs, and supporting documents

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

IC 217505 under ICR 202312-0920-005 · OMB 0920-0576.

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

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Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen (APHIS/CDC Form 4A) 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 4 (A, B, C) Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen Attachment 5 - APHIS-CDC_Form_4_English_Fillable_Clean.pdf 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

917 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 917 0 -264 0 0 1,181
Annual IC Time Burden (Hours) 917 0 -264 0 0 1,181
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Form 4 Guidance Attachment 5 - APHIS-CDC Form 4A_Guidance_track.pdf 01/10/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.