APHIS/CDC Form 3:
Report of a Release/Loss/Theft
The APHIS/CDC Form 3, Report of a Release/Loss/Theft, is used by entities to report a theft, loss, or release of a select agent or toxin. The discovery of a theft, loss, or a release (occupational exposure or release of an agent or toxin outside of the primary barriers of the biocontainment area) of a select agent or toxin is required to be immediately reported. Registered entities report a theft, loss, or release through eFSAP.
Division of Agricultural Select Agents and Toxins
4700 River Road, Unit 2, Mailstop 22, Cubicle 1A07
Riverdale, MD 20737
Fax: 301-734-3652
Email: DASAT@usda.gov
Centers for Disease Control and Prevention
Division of Regulatory Science and Compliance
1600 Clifton Road, NE, Mailstop H21-4
Atlanta, GA 30329
Fax: 404-471-8375
Email: form3@cdc.gov
Guidance Document for the Completion of APHIS/CDC Form 3 [PDF – 505 KB]
- Fillable PDF: APHIS/CDC Form 3 [PDF – 291 KB]
- Print Only PDF: APHIS/CDC Form 3 [PDF – 297 KB]
Please only hand write if using print only form and do not adjust the formatting and text on the form.