APHIS/CDC Form 5: Request for Exemption

The APHIS/CDC Form 5, Request for Exemption, is used by an entity to request an exemption from the select agent regulations for an investigational product. Registered entities request an exemption through eFSAP.

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
FAX: (301) 734-3652
Email: DASAT@usda.gov

Centers for Disease Control and Prevention
Division of Select Agents and Toxins
1600 Clifton Road NE, Mailstop H21-4
Atlanta, GA 30329
FAX: (404) 718-2096
Email: lrsat@cdc.gov

Guidance Document for the Completion of APHIS/CDC Form 5 [PDF – 82 KB]

Fillable PDF: APHIS/CDC Form 5 [PDF – 239 KB]
Print Only PDF: APHIS/CDC Form 5 [PDF – 193 KB]
Please only hand write if using print only form and do not adjust the formatting and text on the form.