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

[CPR] Possession, Use, and Transfer of Select Agents and Toxins (42 CFR 73)

Documents and Forms

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 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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 5	Request for Exemption	Attachment 6 - APHIS-CDC_Form_5_English_Fillable_clean.pdf		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 %

	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

Title	Document	Date Uploaded
Form 5 Guidance	Attachment 6 - APHIS-CDC_Form_5_Guidance_track.pdf	01/10/2024

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