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
Centers for Disease Control and Prevention
Division of Select Agents and Toxins
1600 Clifton Road, NE, Mailstop H21-4
Atlanta, GA 30329
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.