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Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)
Foreign Quarantine Regulations (42CFR71)
OMB: 0920-0134
IC ID: 6646
OMB.report
HHS/CDC
OMB 0920-0134
ICR 202305-0920-006
IC 6646
( )
Documents and Forms
Document Name
Document Type
Form 42CFR 71.21(a)
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)
Form and Instruction
Form 42CFR 71.21(a)
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)
Form and Instruction
42CFR 71.21(a) Maritime Conveyance illness or Death Investigation Form
Attachment D - Maritime Conveyance Illness or Death Investigation Form.pdf
Form and Instruction
42CFR 71.21(a) Maritime Conveyance illness or Death Investigation Form
Attachment D - Maritime Conveyance Illness or Death Investigation Form.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR Subpart C (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
42CFR 71.21(a)
Maritime Conveyance illness or Death Investigation Form
Attachment D - Maritime Conveyance Illness or Death Investigation Form.pdf
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
Quarantine and Traveler-Related Activities, Including Records for Tracing, Investigation and Notification under 42 CFR Parts 70 and 71
FR Citation:
72 FR 70867
Number of Respondents:
500
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
500
0
0
0
0
500
Annual IC Time Burden (Hours)
83
0
0
0
0
83
Annual IC Cost Burden (Dollars)
1,635
0
0
0
0
1,635
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.