42 CFR 70.5 Application to Move from State to State - Communicable Period (Traveler)

Restrictions on Interstate Travel of Persons

OMB: 0920-0488

IC ID: 185658

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42 CFR 70.5 Application to Move from State to State - Communicable Period (Traveler)
 
No Modified
 
Mandatory
 

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

Health Public Health Monitoring

Quarantine and Traveler-Related Activities, Including Records for Contact Tracing, Investigation, and Notification under 42 CFR Parts 70 and 71  72 FR 70867

3,750 0
   
Individuals or Households
 
   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 3,750 0 0 0 0 3,750
Annual IC Time Burden (Hours) 938 0 0 0 0 938
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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