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Maritime Conveyance Illness or Death Investigation
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
OMB: 0920-0821
IC ID: 187997
OMB.report
HHS/CDC
OMB 0920-0821
ICR 201207-0920-003
IC 187997
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0821 can be found here:
2016-03-01 - Revision of a currently approved collection
2015-02-11 - Revision of a currently approved collection
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,873
0
0
0
0
1,873
Annual IC Time Burden (Hours)
219
0
-31
0
0
250
Annual IC Cost Burden (Dollars)
0
0
0
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.