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42 CFR 70.4 Copy of Materials (State or Local Health Authority)
Restrictions on Interstate Travel of Persons
OMB: 0920-0488
IC ID: 185657
OMB.report
HHS/CDC
OMB 0920-0488
ICR 201002-0920-009
IC 185657
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0488 can be found here:
2022-06-29 - Revision of a currently approved collection
2018-11-15 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Att 4_Multi-Purpose Application.doc
Other-WORD
09-20-0171.pdf
SORN 09-20-0171
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
42 CFR 70.4 Copy of Materials (State or Local Health Authority)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Other-WORD
Att 4_Multi-Purpose Application.doc
Yes
Yes
Fillable Printable
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 Contact Tracing, Investigation, and Notification under 42 CFR Parts 70 and 71
FR Citation:
72 FR 70867
Number of Respondents:
20
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
1,500
0
0
0
0
1,500
Annual IC Time Burden (Hours)
150
0
0
0
0
150
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SORN 09-20-0171
09-20-0171.pdf
06/25/2008
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.