Public Health Passenger Locator Form - Illness

Foreign Quarantine Regulations

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0134 can be found here:

Documents and Forms

Document Name Document Type
Public Health Passenger Locator Form - Illness Form
Public Health Passenger Locator Form PLF_09-28-2011_OMB.pdf Form
PLFInstructions_9-28-2011_OMB.docx PLF Instructions IC Document

Information Collection (IC) Details

IC Title:	Public Health Passenger Locator Form - Illness	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
Form	none	Public Health Passenger Locator Form	PLF_09-28-2011_OMB.pdf		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 under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PLF Instructions	PLFInstructions_9-28-2011_OMB.docx	10/03/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.