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
5601 Sunnyside Ave #AP-780-003
Beltsville, MD 20705

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 H21-5
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.