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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.