Continuation Form - Section E

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

CONTINUATION PAGE FOR APPLICATION FOR PERMIT TO IMPORT INFECTIOUS BIOLOGICAL AGENTS INTO THE UNITED STATES

FORM APPROVED OMB NO. 0920-0199 EXP DATE xxxx

Continuation Page of continuation pages

SECTION E continuation (Description of Infectious Biological Agent(s))
4. Scientific name of known/suspected biological agent(s) including Genus and species	5. Strain Designation (list “N/A” if not applicable)	6. Location		7. Laboratory or Storage (Select one or both)		8. Laboratory Safety Level (Leave blank if storage only)	9. Person Responsible for Laboratory
Scientific Name	Strain Designation	Bldg Suite/Room		Lab Storage		Safety Level	Responsible Person

CDC Form 0.753 (Continuation), Revised January 2014