Information Collection

Maritime Conveyance Illness or Death Investigation

IC 187997 under ICR 201207-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Maritime Conveyance Illness or Death Investigation	Form and Instruction
Maritime Conveyance Illness or Death Investigation Attachment H Maritime investigation form_June22 2012.docx	Form and Instruction

IC Title:

Maritime Conveyance 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 and Instruction	none	Maritime Conveyance Illness or Death Investigation	Attachment H Maritime investigation form_June22 2012.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

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: 1,873

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,873	0	1,873
Annual IC Time Burden (Hours)	219	-31	250
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.