Amendment Request Attachment

Amendment Request Attachment

NEW TRANSGENIC STRAINS

Instructions: This attachment must accompany a General Amendment Request Form; an Amended Animal Tables Attachment is also required. In addition, please review the Genetically-Modified Animals Guideline.

PROTOCOL NUMBER: / DATE:
PRINCIPAL INVESTIGATOR:

A.Are you exposing/infecting the new transgenic animals to any potentially infectious and/or biological agents (i.e. bacteria, yeast, fungi, viruses, rDNA, parasites, human cells/ tissue), biological toxins, hazardous chemical agents, or radioisotopes?

NO
YES; please include aHazardous Agents Attachment. If this protocol already has a new version of the Hazardous Agents Form (an attachment separate from the protocol application), update the approved version and submit it with this amendment.

B.Describe any special care or monitoring that the animals will require, or need for special breeding systems.

No special care required
Special care required (describe below):

C.For each strain: what is the identity of the inserted or knocked-out gene (avoid abbreviations; for an inserted gene, indicate the source species, wild-type or mutant; if mutant, indicate how) and what is the function of the wild-type gene product?

D.Will these modifications to the genome cause an increased risk for the animal to shed intentionally introduced infectious agents, biological toxins, hazardous chemical agents, radioisotopes or create other hazards for the animal handlers and research staff?

NO
YES Explain the hazard the animal will present to staff handling the animals and provide safety precautions required to be
observed in housing and handling these animals in the space below.

E.Are two or more different strains of transgenic animals being bred?

NO
YES

i.Which strains are being bred?

ii.What is the expected biological characteristic(s) or outcome of the novel strain(s)?

iii.Will the novel strain(s) pose any additional risks to staff? If yes, please explain.

Form Approved: December 2012Amendment Request Attachment - NEW TRANSGENIC STRAINS

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