APHIS/CDC Form 3

Report of Theft, Loss, or Release of Select Agents and Toxins

The APHIS/CDC Form 3, Report of Theft, Loss, or Release of Select Agents and Toxins, 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:

Centers for Disease Control and Prevention
Division of Select Agents and Toxins
1600 Clifton Road, NE, Mailstop A-46
Atlanta, GA 30329
Fax: 404-471-8375
Email: LRSAT@cdc.gov
Phone: 404-718-2000
Animal and Plant Health Inspection Service
Agriculture Select Agent Services
4700 River Road, Unit 2, Mailstop 22, Cubicle 1A07
Riverdale, MD 20737
Fax: 301-734-3652
Email: AgSAS@aphis.usda.gov
Phone: 301-851-3300 option 3 (voice only)

Guidance Document for the Completion of APHIS/CDC Form 3Adobe PDF (PDF 412KB)

APHIS-CDC Theft Loss Release Information Adobe PDF (PDF 1.3MB)

Fillable PDF: APHIS/CDC Form 3 PDF version (PDF 207KB) (Adobe Reader 6.0 or greater required)

Print Only PDF: APHIS/CDC Form 3 PDF version (PDF 78KB)