Information Collection

42 CFR 70.4 Report by Master of Vessel or Person in Charge of Conveyance

IC 185656 under ICR 201301-0920-007 · OMB 0920-0488.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0488 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
42 CFR 70.4 Report by Master of Vessel or Person in Charge of Conveyance	Form
Restriction on Travel of Persons - Report from Master of Attachment 4 Master of Vessel or Conveyance Illness Report 101712.doc	Form
09-20-0171.pdf SORN 09-20-0171	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

42 CFR 70.4 Report by Master of Vessel or Person in Charge of Conveyance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	Restriction on Travel of Persons - Report from Master of Vessel	Attachment 4 Master of Vessel or Conveyance Illness Report 101712.doc		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 under 42 CFR Parts 70 and 71

FR Citation: 72 FR 70867

Number of Respondents: 1,500

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	Previously Approved
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SORN 09-20-0171	09-20-0171.pdf	06/25/2008

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