Summary of Changes

QARS Forms - Summary of Changes

OMB Control 090-0821

1. Justification for Changes

The Quarantine Activity Reporting System (QARS) is used by the quarantine station staff to record activities and follow up on illness reports, among other activities.

• Eliminated free text fields and replaced with standardized choices to enhance collection of necessary data points.

• Created a uniform flow of data collection across all three forms.

• Standardized vocabulary so that phrasing of questions is consistent across all forms.

• Removed unnecessary questions to reduce user burden.

• Merged related questions into one standardized query to streamline data collection.

2. General Changes

All Forms

• Rearranged Sections: Rearranged sections to ensure consistent data flow across all forms. All sections names across forms are identical, eg. Section 1 ‘Quarantine Station Notification’, Section 2 ‘Information on Signs and Symptoms’.

• Renamed Field Labels: Rephrased questions so that the same question is asked the exact same way across the board. Renamed fields so that field names are identical across forms. For example, eliminated having ‘first name’ in one form, and ‘given name’ in another.

• Standardized Text Fields: Eliminated free text fields. Open questions converted to closed format with check boxes provided to allow used to make a specified selections. For example, under treatment history, date fields provided instead of multiple open text fields to specify treatment dates. In the maritime form, the free text field chest x-ray results was converted to check box fields indicating if the results were normal/abnormal and if cavitation/no cavitation.

• Consolidated Multiple Fields: Quantity of questions reduced by merging multiple fields into single; eg., rather than asking for the detailed activities of each and every country visited, this question is now asked once, requesting only relevant exposure information.

• Eliminated Questions: Removed questions that have little or no relevance to the illness investigation. For example, race and ethnicity, visa type, legal status etc. Also removed questions that may not be pertinent for the investigation; eg., location of isolation, onset date for headache, etc.

• Removed Specific Questions: Removed questions that are specific to certain confirmed illnesses that pose a public threat, which would be asked as part of a more detailed investigation.

Maritime

• Consolidated 2 Forms: Combined the previously approved ‘International Maritime Conveyance Illness or Death Investigation Form’ and the ‘International Maritime Conveyance Illness or Death Report’ to a single form (resulting in elimination of multiple questions).

3. Estimate of Annualized Burden Hours and Costs

• Number of respondents has been updated to reflect 2009 data

• The hourly wage rate remains $17.75 per hour for 2009

• The new calculated burden hours are based on piloted forms conducted by three quarantine public health officers.

3.1 Estimate of Total Burden Hours

Form	Number of Respondents (2009)	Number of Responses per Respondent	Average Burden per Response (in minutes)	Total Burden Hours
Air Travel Illness or Death Investigation Form	1,626	1	6/60 min	163
Maritime Conveyance Illness or Death Investigation Form*	1,873**	1	8/60 min	250
Land Travel Illness or Death Investigation Form	259	1	6/60 min	26
Total	3,758			439

* One number is provided for the ‘ Maritime Conveyance Illness or Death Investigation Form’. The original form also included a separate number for the ‘International Maritime Conveyance Illness or Death Report’ which has been eliminated and is now included in the form.

** Maritime data for 2009 includes 1,369 records that were electronically transmitted via the newly developed MIDRS (Maritime Illness and Death Reporting) system.

3.2 Estimate of Annualized Cost to Respondents

Form	Total Burden Hours	Hourly Wage Rate	Total Respondent Costs
Air Travel Illness or Death Investigation Form	163	$17.75	$2,893
Maritime Conveyance Illness or Death Investigation Form*	250	$17.75	$4,438
Land Travel Illness or Death Investigation Form	26	$17.75	$462
Total	439	$17.75	$7,793

4. New Fields

New fields will have no impact on the burden, since they filled in by the Quarantine Medical Officer and Quarantine Public Health Officers (QMO/QPHO) conducting the investigation.

Section 1: Quarantine station notification

• CDC User ID

• QARS Unique ID # (Air only)

• State (Air only)

• When was the QS notified?

• Conveyance Type (new for Air and Land only)

• Was the travel domestic or international?

Section 2: Information on signs and symptoms of ill or deceased person

The following values were added to the list of signs and symptoms that the QMO/QPHO will have to look for. For some symptoms the onset date is also requested.

• Fever – new questions:

□ History of fever (not measured)

□ Feel warm to the touch

• Coryza/runny nose (Land only)

• Swollen glands, location (Air only)

• Jaundice, onset date (Air only)

• Injury (Air and Maritime only)

• Chronic condition

Section 6: Additional information about deceased person

• NO impact on burden rate: The following questions are additional questions that the QMO/QPHO will fill in but will not ask during the investigation

• Date of Death (Land only)

• Time of death (24hrs) (Land only)

• Suspected cause of death (Land only)

• Body released to medical examiner? Yes/no (Land only)

Determined cause of death (Air and Land)

• City/country (Air and Land)

• Medical examiner telephone (Maritime and land)

Other Fields

Section 4: General information about the ill or deceased person

The following are new questions that will be asked during the investigation:

• Maternal name and other name used (Maritime only)

• E-Mail (Maritime and Air only)

• Cell, number of days reachable (Maritime only)

• Emergency contact name, relationship and phone (Maritime only)

Section 5: Border Crossing Information (Land Form Only)

The following are new questions that will be asked during the investigation:

• Contact information collected on conveyance passengers/drives - yes/no (Land only)

Section 5: Vessel Information (Maritime Form Only)

• Voyage number

• Itinerary

Section 7: Exposure and contact history of ill or deceased person

The following question will be asked during the investigation:

• How many travelling companions are ill?

Section 8: Disposition of ill person (last grayed out section for Maritime)

The following question will be asked during the investigation:

• Disposition of ill person was: (Air and Maritime)

5. Fields Removed

Note: Section numbers vary across forms therefore have not been included.

All the removed fields reduce the burden rate, since these were questions asked by the QMO/QPHO during the contact investigation.

Information on signs and symptoms of ill or deceased person

• Choices under the “Condition not requiring public health follow-up” field (Land only)

Pertinent medical history/Vaccinations

• Do you have underlying condition medical conditions that could explain your current symptoms? Yes/No

• Rapid Influenza Test Date and Result (Maritime only)

• Place isolated and whether or not there was contact with others during isolation (Maritime only)

• Treatment given at POE If yes, what was done and by whom? (Land only)

• Treatment given during travel, but prior to crossing the border? If yes, what was done and by whom? (Land only)

• Treatment given after crossing the border? If yes, what was done and by whom? (Land only)

History of current illness

• Passenger had contact with someone with a rash/known chickenpox/measles/rubella in the last 3 weeks?

General information about ill or deceased person

• Race (Land only)

• Ethnicity (Land only)

• Visa type (Land only)

• Alien number (Land and Air only)

Border crossing (Land only)

• Express Lane

• Was the Traveler coming from an airport?

• Company owned, specify

• Rental, specify

• Did conveyance transport cargo?, if yes, specify

• Departure Time

• Expected arrival time

Exposure history

• Removed detail for each country (turned into generic questions)

• Visited urban areas

• How long ago?

• Number of traveling companions

• Number of drivers (Land only)

• Name of driver(s), with space to enter for 3 drivers (Land only)

• Driver’s license number(s), with space to enter for 3 drivers (Land only)

• Does this crew member eat in passenger venues? (Maritime only)

• Do any of the above persons have similar signs & symptoms? If yes, explain (Maritime only)

General information about the diseased person (Air and Maritime only)

• Title of person body released to

• Agency (Air only)

• Office telephone (Air only)

• Cell (Air only)

• e-mail (Air only)

• Laboratory test results (Maritime only)

Agencies contacted section (Land only)

Entire section was removed

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