View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Reporting the Identification of a Select Agent or Toxin from a Clinical/Diagnostic Specimen (Form 4)	Agency IC Tracking Number:	0920-0576 18FL

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	4A				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: 1,181	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	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

Documents for IC

Title	Document	Date Uploaded
Minor Changes to Form 4 (March 2022)		03/21/2022

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

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