Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries

2022 Ebola Airport Entry Questionnaires

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1375 can be found here:

Documents and Forms

Document Name Document Type
Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries Form and Instruction
PUBLIC HEALTH ASSESSMENT FOR TRAVELERS FROM EBOLA OUTBRE Attachment D-Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	PUBLIC HEALTH ASSESSMENT FOR TRAVELERS FROM EBOLA OUTBREAK-AFFECTED COUNTRIES	Attachment D-Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0171 - Quarantine- and Traveler-Related Activities	FR Citation: 83 FR 6591

Number of Respondents: 5,365	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,365	5,365
Annual IC Time Burden (Hours)	1,788	1,788
Annual IC Cost Burden (Dollars)	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.