Information Collection

Request for Exemption of Select Agent and Toxin for an Investigational Product (APHIS/CDC Form 5)

IC 217507 under ICR 202312-0920-005 · OMB 0920-0576.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 5 Request for Exemption of Select Agent Agent and Toxin for an Investigational Product (APHIS/CDC Form 5)	Form
Form Form 5 Request for Exemption Request for Exemption of Select Agent Agent and Toxin for an Investigational Product (APHIS/CDC Form 5)	Form
Form 5 Request for Exemption Attachment 6 - APHIS-CDC_Form_5_English_Fillable_clean.pdf	Form
Form 5 Request for Exemption Attachment 6 - APHIS-CDC_Form_5_English_Fillable_clean.pdf	Form
Attachment 6 - APHIS-CDC_Form_5_Guidance_track.pdf Form 5 Guidance	IC Document
Attachment 6 - APHIS-CDC_Form_5_Guidance_track.pdf Form 5 Guidance	IC Document

IC Title:

Request for Exemption of Select Agent Agent and Toxin for an Investigational Product (APHIS/CDC Form 5)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 5				Yes	Yes	Fillable Fileable

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: 1

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form 5 Guidance		01/10/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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