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Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English)
Emergency Submission to Supplement OMB Control Number 0920-0821 in the context of Screening Travelers for Ebola Risk
OMB: 0920-1031
IC ID: 213992
OMB.report
HHS/CDC
OMB 0920-1031
ICR 201411-0920-008
IC 213992
( )
Documents and Forms
Document Name
Document Type
Form 0920-1031
Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English)
Form and Instruction
0920-1031 Attachment B1 CDC Form Ebola Risk Assessment - English
Attachment B1 CDC Form Ebola Risk Assessment - English.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English)
Agency IC Tracking Number:
0920-15FM
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-1031
Attachment B1 CDC Form Ebola Risk Assessment - English
Attachment B1 CDC Form Ebola Risk Assessment - English.docx
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
304
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
304
0
304
0
0
0
Annual IC Time Burden (Hours)
76
0
76
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.