Form 2070 - Application For Authorization To Ship Master Seed Or Cell Samples For Confirmatory Testing By Aphis

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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it

OMB Approval

displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0013. The time required to complete this information collection is

0579-0013

estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and

EXP DATE: 03/2018

completing and reviewing the collection of information.

INSTRUCTIONS: See reverse side.

This application may be submitted to request authorization to ship biological samples for confirmatory testing by APHIS.

U.S. DEPARTMENT OF AGRICULTURE

1. NAME AND FULL MAILING ADDRESS OF APPLICANT

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES, CENTER FOR VETERINARY BIOLOGICS (CVB)

1920 DAYTON AVE, AMES, IA 50010

APPLICATION FOR AUTHORIZATION TO SHIP MASTER SEED OR CELL

SAMPLES FOR CONFIRMATORY TESTING BY APHIS



2. U.S. VET. EST.

3. APPLICATION TYPE:

NEW

AMENDMENT

NO.

TO SUBMISSION DATED______________

AND/OR PRIOR CVB MAIL LOG NO______________

CVB USE ONLY

4. ITEM(S) TO BE SHIPPED (USE SEPARATE FORM FOR EACH SEED OR CELL)

A. COMPLETE IDENTIFICATION OF SEED/CELL, EXACTLY AS IT APPEARS ON CONTAINERS

B. PASSAGE

C. HOW TO BE

D. BIOTECH-

E. QUANTITY

(INCLUDING LOT NO.)

SHIPPED

DERIVED

REQUESTED BY APHIS



BASELINE PASSAGE

DRY ICE



LIQUID



YES

NITROGEN



HIGH PASSAGE (CELLS AND BIOTECHNOLOGY-DERIVED SEEDS ONLY)



OTHER (describe)

X+______

PARENTAL CONSTRUCT (BIOTECHNOLOGY-DERIVED ONLY)

CHECKLIST OF SUPPORTING MATERIAL

A. WITH THIS

B. DATE AND/OR

DESCRIPTION

ITEM

APPLICATION

CVB MAIL LOG ID OF

(SEE INSTRUCTIONS ON REVERSE SIDE FOR ADDITIONAL GUIDANCE)

("X")

PRIOR SUBMISSION

5. MASTER SEED OR CELL REPORT

HISTORY, PREPARATION, AND TESTING OF SEED OR CELL

STEPWISE PROCEDURES FOR NON-CODIFIED ASSAYS

6. ASSAY PROTOCOLS

USED TO TEST SEED/CELL

7. SUMMARY OF INFORMATION FORMAT

FOR BIOTECHNOLOGY-DERIVED OR IMPORTED SEEDS/CELLS

8. ELECTRONIC FILES CONTAINING

BIOTECHNOLOGY-DERIVED SEEDS/CELLS

OR AS REQUESTED BY APHIS

GENETIC SEQUENCE DATA

9. OTHER

10. BY DEFAULT, ALL CVB COMMUNICATIONS ARE DIRECTED TO THE APHIS LIAISON FOR THE ESTABLISHMENT. IF YOU WISH TO DESIGNATE A LABORATORY CONTACT TO HANDLE

COMMUNICATIONS FOR THIS SEED/CELL, LIST THIS INDIVIDUAL BELOW.

A. CONTACT NAME

B. PHONE

C. EMAIL

11. OTHER COMMENTS

I agree to ship samples in accordance with applicable USDA and hazardous shipping regulations and to provide any reagents requested by the CVB. I agree to

provide the CVB with an anticipated shipping date, ideally 2 weeks beforehand. Once shipped, I will provide tracking information.

13. SIGNATURE OF APPLICANT (Paper Submissions Only)

12. PRINTED NAME AND TITLE OF APPLICANT

14. DATE SUBMITTED

FOR CENTER FOR VETERINARY BIOLOGICS USE ONLY

The applicant is authorized to ship the above Seed/Cell to the CVB, with any Exceptions that may be attached (i.e., if there is a check in the box in item 19). The

CVB Laboratory Coordinator (item 17) will contact the APHIS liaison or, if applicable, the designated Contact (item 10) to discuss needed reagents. Ship the

requested quantity of samples and reagents under cover of APHIS Form 2020, noting the test authorization and, if applicable, institutional biosafety committee

numbers in the Remarks section. Ship to the CVB address listed above, addressed to the attention of the CVB Laboratory Coordinator.

15. TEST AUTHORIZATION NO

16. INSTITUTIONAL BIOSAFETY COMMITTEE NO (genetically modified Seed/Cell only)

17. CENTER FOR VETERINARY BIOLOGICS LABORATORY COORDINATOR

18. COORDINATOR’S EMAIL



20. DATE APPROVED

21. CVB MAIL LOG NO.

19. APPLICATION APPROVED BY (Signature)

CVB EXCEPTIONS ATTACHED

APHIS FORM 2070

OCT 2015