APHIS/CDC Form 4: Report of the Identification of a Select Agent or Toxin
These expired forms can continue to be used because the revision package is currently under review by the Office of Management and Budget.
The APHIS/CDC Form 4, Report of the Identification of a Select Agent or Toxin, is used by clinical or diagnostic laboratories and other entities to notify the Federal Select Agent Program of the identification of a select agent or toxin as the result of diagnosis, verification, or proficiency testing and of the final disposition of that identified agent or toxin. Registered entities report the identification of select agents and toxins through eFSAP.
For non-registered clinical or diagnostic laboratories and other entities, Tier 1 select agents and toxins listed below are required to be immediately reported to Federal Select Agent Program and then submit APHIS/CDC Form 4 within 7 calendar days of identifications and within 90 days of receipt of the proficiency sample.
Tier 1 Select Agents and Toxins
HHS Agents and Toxins
- Bacillus cereus Biovar anthracis
- Botulinum neurotoxins
- Botulinum neurotoxin producing species of Clostridium
- Ebola virus
- Francisella tularensis
- Marburg virus
- Variola major virus (Smallpox virus)
- Variola minor virus (Alastrim)
- Yersinia pestis
- Bacillus anthracis
- Burkholderia mallei
- Burkholderia pseudomallei
- Foot-And-Mouth Disease virus
- Rinderpest virus
Animal and Plant Health Inspection Service
Division of Agricultural Select Agents and Toxins
4700 River Road, Unit 2, Mailstop 22, Cubicle 1A07
Riverdale, MD 20737
Form 4 Downloads
For assistance in the completion of APHIS/CDC Form 4, please refer to the guidance document below. This guidance document provides detailed information and direction on how to complete all sections of APHIS/CDC Form 4.
Please only hand write if using print only form and do not adjust the formatting and text on the form.
- APHIS/CDC Form 4A – Reporting the Identification from a Clinical/Diagnostic Specimen
- Form 4A-AB
- Form 4A-CD
- APHIS/CDC Form 4B – Reporting the Identification from a Proficiency Test
- APHIS/CDC Form 4C – Federal Law Enforcement Reporting Seizure of Select Agent or Toxin