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Cumulative Influenza/Influenza-Like Illness (ILI) Form
Foreign Quarantine Regulations (42CFR71)
OMB: 0920-0134
IC ID: 234012
OMB.report
HHS/CDC
OMB 0920-0134
ICR 202305-0920-006
IC 234012
( )
Documents and Forms
Document Name
Document Type
Cumulative Influenza/Influenza-Like Illness (ILI) Form
Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form
Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form
Attachment E - Maritime Conveyance Cumulative Influenza or Influenza-Like Illness (ILI) Form.pdf
Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form
Attachment E - Maritime Conveyance Cumulative Influenza or Influenza-Like Illness (ILI) Form.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Cumulative Influenza/Influenza-Like Illness (ILI) Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 71
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
none
Cumulative Influenza/Influenza-Like Illness (ILI) Form
Attachment E - Maritime Conveyance Cumulative Influenza or Influenza-Like Illness (ILI) Form.pdf
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 Tracing Contact Investigation
FR Citation:
72 FR 7086
Number of Respondents:
3,000
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
3,000
0
0
0
0
3,000
Annual IC Time Burden (Hours)
100
0
0
0
0
100
Annual IC Cost Burden (Dollars)
3,893
0
0
0
0
3,893
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.