Information Collection

Land Border Illness or Death Investigation

IC 187999 under ICR 201012-0920-003 · OMB 0920-0821.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0821 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Land Border Illness or Death Investigation	Form
Land Travel Illness or Death Investigation Attachment G Land Travel Illness or Death Investigation form.docx	Form

IC Title:

Land Border Illness or Death Investigation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Land Travel Illness or Death Investigation	Attachment G Land Travel Illness or Death Investigation form.docx		Yes	No	Fillable Fileable

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

FR Citation: 72 FR 70867

Number of Respondents: 259

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	259	199	60
Annual IC Time Burden (Hours)	26	20	6
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.