OMB
.report
Search
Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen (APHIS/CDC Form 4A)
[CPR] Possession, Use, and Transfer of Select Agents and Toxins (42 CFR 73)
OMB: 0920-0576
IC ID: 217505
OMB.report
HHS/CDC
OMB 0920-0576
ICR 202312-0920-005
IC 217505
( )
Documents and Forms
Document Name
Document Type
Form APHIS/CDC Form 4 (
Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen (APHIS/CDC Form 4A)
Form and Instruction
APHIS/CDC Form 4 ( Reporting the Identification of a Select Agent or Toxin
Attachment 5 - APHIS-CDC_Form_4_English_Fillable_Clean.pdf
Form and Instruction
APHIS/CDC Form 4 ( Reporting the Identification of a Select Agent or Toxin
Attachment 5 - APHIS-CDC_Form_4_English_Fillable_Clean.pdf
Form and Instruction
Attachment 5 - APHIS-CDC Form 4A_Guidance_track.pdf
Form 4 Guidance
IC Document
Attachment 5 - APHIS-CDC Form 4A_Guidance_track.pdf
Form 4 Guidance
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen (APHIS/CDC Form 4A)
Agency IC Tracking Number:
0920-0576
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
09-20-0170 National Select Agent Registry/Select Agent Transfer and Entity Registration Information System
FR Citation:
76 FR 4483
Number of Respondents:
917
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
Documents for IC
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.