OMB
.report
Search
Land Passenger Locator Form
[NCEZID] Land Travel-related Public Health Activities
OMB: 0920-0134
IC ID: 279492
OMB.report
HHS/CDC
OMB 0920-0134
ICR 202603-0920-008
IC 279492
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Land Passenger Locator Form
Agency IC Tracking Number:
0920-26-0139
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
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
n/a
Public Health Land Passenger Locator Form
Attachment D - Land Passenger Locator Form.docx
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 Travel Related Activities, Including Records for Contact Tracing
FR Citation:
72 FR 239
Number of Respondents:
210
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
Requested
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
210
0
210
0
0
0
Annual IC Time Burden (Hours)
18
0
18
0
0
0
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.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.