APHIS/CDC Form 4 - Report of Identification of a Select Agent or Toxin in a Clinical or Diagnostic Laboratory

Description

For all identified select agents and toxins, a completed and signed APHIS/CDC Form 4 should be mailed or faxed directly to APHIS or CDC within 7 calendar days after identification of the select agent or toxin contained in a specimen presented for diagnosis or verification within 90 days of receipt for proficiency testing.

Immediate Notification:

Clinical or diagnostic laboratories and other entities that have identified the following select agents and toxins contained in a specimen presented for diagnosis, verification, or proficiency testing are required by regulation (7 CFR 331, 9 CFR 121, and 42 CFR 73) to contact APHIS or CDC immediately:

• African horse sickness virus
• African swine fever virus
• Avian influenza virus (highly pathogenic)
• Bacillus anthracis
• Botulinum neurotoxins
• Bovine spongiform encephalopathy agent
• Brucella melitensis
• Classical swine fever virus
• Foot-and-Mouth disease virus
• Francisella tularensis
• Ebola viruses
• Hendra virus
• Lassa fever virus
• Liberobacter africanus
• Liberobacter asiaticus
• Marburg virus
• Newcastle disease virus (velogenic)
• Nipah virus
• Peronosclerospora philippinensis
• Ralstonia solanacearum race 3 biovar 2
• Rift Valley fever virus
• Rinderpest virus
• Schlerophthora rayssiae var zeae
• South American Hemorrhagic Fever viruses (Junin,Machupo,Sabia,Flexal,Guanarito)
• Swine vesicular disease virus
• Synchytrium endobioticum
• Variola major virus (Smallpox virus)
• Variola minor (Alastrim)
• Venezuelan equine encephalitis virus
• Xanthomonas oryzae pv. oryzicola
• Xylella fastidiosa (citrus variegated chlorosis strain)
• Yersinia pestis

Directions

If you will be completing the form electronically, download the fillable PDF below, then complete print, and sign the form. If you will be completing the form by hand, use the print only PDF, then print, complete and sign the form. All completed forms must be submitted via fax or mail directly to CDC or APHIS.

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