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Preboarding Health Screen
2019 Novel Coronavirus Airport Entry Questionnaires
OMB: 0920-1287
IC ID: 239869
OMB.report
HHS/CDC
OMB 0920-1287
ICR 202005-0920-013
IC 239869
( )
Documents and Forms
Document Name
Document Type
Form 0920-20HF
Preboarding Health Screen
Form and Instruction
0920-20HF Preboarding Health Screen
Attachment F COVID-2019 Preboarding Health Screen_2.10.2020-Final.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Preboarding Health Screen
Agency IC Tracking Number:
0920-20HF
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
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
0920-20HF
Preboarding Health Screen
Attachment F COVID-2019 Preboarding Health Screen_2.10.2020-Final.pdf
No
Paper Only
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:
20,000
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
20,000
0
0
0
0
20,000
Annual IC Time Burden (Hours)
1,667
0
0
0
0
1,667
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.