Justification for Change - revised 9.18

Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing (OMB Control No. 0920-0821) Expiration date 8/31/2015

Program Contact

Amy McMillen

Office of Policy and Planning

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS C12

Atlanta, Georgia 30333

Phone: (404) 639-1045

Email: auh1@cdc.gov

Submission Date: September 5, 2014

Circumstances of Change Request for OMB 0920-0821

In order to more quickly and effectively assess the risk for Ebola in travelers to the United States from affected countries, CDC requests approval for a nonmaterial/non-substantive change to OMB 0920-0821: Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing (expiring 8/31/2015). CDC requests the addition of one form, the Exposure Risk Assessment For Travelers From Ebola Outbreak-Affected Countries form. An increase of five hours of respondent burden is estimated for 0920-0821 as a result of asking six additional questions specific to risk for Ebola infection.

Description of Changes

This is a request for information collection tool to supplement CDC’s routine illness and death investigations so that CDC can use the Ebola Exposure Risk Assessment for Travelers from Outbreak-affected Countries form to assess travelers who are identified during travel (e.g. reported to CDC by airlines per regulation 42 CFR part 71.21) as meeting criteria for required or requested reporting and who are traveling from the affected region. CDC has approved Illness and Death Investigation forms (0920-0821) to assist in routine responses to illnesses, but these forms do not have the specificity needed to perform an assessment given known risks characterized during this Ebola outbreak. Given that subject matter experts have determined that there are specific exposures and symptoms that put individual at a higher risk for Ebola, CDC can, with the requested form, provide a more thorough, efficient, and timely risk assessment.

When Quarantine Officers are present at the port of entry, they often respond in person to conduct the assessment of an ill traveler. However, there are many instances in which a Quarantine Officer may not be able to meet a conveyance or border crosser in person, including (but not limited to) the following: the conveyance arrives at a port of entry that does not have Quarantine Station on site; Quarantine Officers are already responding to another illness report; or the illness may be reported after hours and Quarantine Officers cannot arrive in time to meet the conveyance or border crosser without causing substantial delays to travel. If Quarantine Officers are unable to respond in-person, they provide phone consultation to port partners (e.g., Emergency Medical Services (EMS), CBP Officers) on the scene, to determine the public health importance of the illness. In both circumstances, an interview of the ill person(s) is required to conduct the public health assessment, whether in-person, by phone, or through a trained responder (in consultation with the Quarantine Officer). The assessment this new form allows will be performed prior to the individual leaving the port of entry after arrival. This can either be on the conveyance, in the terminal, by Customs and Border Protection in their space at the port of entry, or in CDC’s office space at the port of entry.

While cooperation with CDC during this proposed risk assessment is voluntary, if an individual refused to provide the requested information, or is not truthful about the information provided during an illness investigation, CDC may, if it is reasonably believed that the individual is infected with or has been exposed to Ebola, quarantine, isolate, or place the individual under surveillance under 42 CFR 71.32 and 71.33.

Burden

Estimates of Annualized Burden Hours 0920-0821 Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing (increase of five hours)

Form	Number of Respondents	Number of Responses per Respondent	Average Burden per Response (in minutes)	Total Burden Hours
Airline Travel Illness or Death Investigation Form	1626	1	5/60	136
Maritime Conveyance Illness or Death Investigation Form	1873	1	5/60	156
Land Travel Illness or Death Investigation Form	259	1	5/60	22
Ebola Exposure Risk Assessment for Travelers from Outbreak-affected Countries	100	1	3/60	5
Total	3,858			319

Estimates of Annualized Cost Burden 0920-0821 Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing. There is an increase of $418 dollars. Included in this increase is an adjustment for increase in the average wage from 2012 to 2013. Wages for Passengers were gathered from 00-0000 All Occupations (http://www.bls.gov/oes/current/oes_nat.htm#00-0000)

Form	Total Burden Hours	Hourly Wage Rate	Total Respondent Costs
Airline Travel Illness or Death Investigation Form	136	$22.33	$3,037
Maritime Conveyance Illness or Death Investigation Form*	156	$22.33	$3,483
Land Travel Illness or Death Investigation Form	22	$22.33	$491
Ebola Exposure Risk Assessment for Travelers from Outbreak-affected Countries	5	$22.33	$112
Total	377	$22.33	$7,123

Privacy Impact Assessment

There is no PII collected on the Ebola Exposure Risk Assessment for Travelers from Outbreak-affected Countries form, so there will be no effect on the Privacy Impact Assessment provided in the supporting statement for the information collection approved under OMB 0920-0821. All of the procedural and physical safeguards and access requirements to the collected information remain the same.

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