Form 0920-1260 Three-day Pre-embarkation AGE Illness Assessment (all cr

Maritime Illness Database and Reporting System (MIDRS)

Att5e 3DyPre-embrktnAGEIllnssAssmnt (non-standard) 20220125

Three-day Pre-embarkation AGE Illness Assessment (all crew members)

OMB: 0920-1260

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Attachment 5c. Three-day Pre-embarkation AGE Illness Assessment


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Form Approved

OMB No. 0920-1260

Exp. Date 04/30/2022



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CDC estimates the average reporting burden for this collection of information as three minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering, and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1260).



The Vessel Sanitation Program does not require a standard form for this information; however, the requirement to collect and maintain this information is documented in the Vessel Sanitation Program 2018 Operations Manual.

Source: Vessel Sanitation Program 2018 Operations Manual




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorNCEH/ATSDR Office of Science
File Modified0000-00-00
File Created2022-04-06

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