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71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)
Maritime Illness Database and Reporting System (MIDRS)
OMB: 0920-1260
IC ID: 235047
OMB.report
HHS/CDC
OMB 0920-1260
ICR 202204-0920-002
IC 235047
( )
Documents and Forms
Document Name
Document Type
71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)
Form and Instruction
Gastrointestinal Illness (GI) Template
Att5a.MIDRSTemplate.txt
Form and Instruction
Gastrointestinal Illness (GI) Template
Att5a.MIDRSTemplate.txt
Form and Instruction
MIDRS Template - screenshot
Att8.MIDRSscreenshot.docx
Form and Instruction
MIDRS Template - screenshot
Att8.MIDRSscreenshot.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
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
NA
Gastrointestinal Illness (GI) Template
Att5a.MIDRSTemplate.txt
NA
Yes
Yes
Fillable Fileable
Form and Instruction
NA
MIDRS Template - screenshot
Att8.MIDRSscreenshot.docx
NA
Yes
Yes
Fillable Fileable
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:
250
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
95 %
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
0
0
-2,500
0
0
2,500
Annual IC Time Burden (Hours)
0
0
-125
0
0
125
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.