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Air Travel Illness or Death Investigation
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
OMB: 0920-0821
IC ID: 188000
OMB.report
HHS/CDC
OMB 0920-0821
ICR 201601-0920-011
IC 188000
( )
Documents and Forms
Document Name
Document Type
Air Travel Illness or Death Investigation
Form
Air Travel Illness or Death Investigation
Attachment G Air investigation Form 3_28_2012 FINAL.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Air Travel Illness or Death Investigation
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
none
Air Travel Illness or Death Investigation
Attachment G Air investigation Form 3_28_2012 FINAL.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Quarantine and Traveler Related Activities, including Records for Contact Tracing Investigation and Notification
FR Citation:
72 FR 70867
Number of Respondents:
1,800
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
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
1,800
0
174
0
0
1,626
Annual IC Time Burden (Hours)
150
0
14
0
0
136
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.