Non-substantive Change_Quarantine Station Illness Response Forms 092

Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing (OMB Control No. 0920-0821) Expiration date 8/31/2015

Program Contact

Amy McMillen

Office of Policy and Planning

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, N.E., MS C12

Atlanta, Georgia 30333

Phone: (404) 639-1045

Email: [email protected]

Submission Date: March 29, 2013

Circumstances of Change Request for OMB 0920-0821

CDC requests approval for a nonmaterial/non-substantive change to OMB 0920-0821: Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing (expiring 8/31/2015). CDC requests that sections 1-3 of the Maritime Illness and Death Investigation form (Attachment A) be eliminated for the purposes of this information collection. A decrease of 63 hours of respondent burden is estimated for 0920-0821 as a result of streamlining the data collection process for reporting cases of non-gastrointestinal (non-GI) illness or death.

Description of Changes

The voluntary Maritime Illness and Death Investigation forms (Attachment A) approved in OMB 0920-0821: Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing allow CDC to follow-up with ships or ill individuals after an initial report of illness or death is received prior to the ships’ arrival. These forms are also used by Quarantine Station staff to collect information for follow-up and tracking (surveillance) purposes.

CDC has identified redundant information collection in OMB packages 0920-0134 and 0920-0821 concerning reports of illness and death from cruise ships. CDC requests that sections 1-3 of the Maritime Illness and Death Investigation form approved in OMB 0920-0821 be eliminated for the purposes of this information collection.

If this request is approved, only sections 4-5 of the Maritime Illness and Death Investigation form will be included in 0920-0821. This will reduce the response burden from 7 minutes to 5 minutes.

Burden

Estimates of Annualized Burden Hours 0920-0821 Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing (decrease of 63 hours)

Form	Number of Respondents (2009, incl. H1N1)	Number of Responses per Respondent	Average Burden per Response (in minutes)	Total Burden Hours
Airline Travel Illness or Death Investigation Form	1626	1	5/60	136
Maritime Conveyance Illness or Death Investigation Form	1873	1	5/60	156
Land Travel Illness or Death Investigation Form	259	1	5/60	22
Total	3,758			314

Estimates of Annualized Cost Burden 0920-0821 Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing (decrease of $1,345 dollars)

Form	Total Burden Hours	Hourly Wage Rate	Total Respondent Costs
Airline Travel Illness or Death Investigation Form	136	$21.35	$2,904,
Maritime Conveyance Illness or Death Investigation Form*	156	$21.35	$3,331
Land Travel Illness or Death Investigation Form	22	$21.35	$470
Total	377	$21.35	$6,705

Privacy Impact Assessment

This change in how ships report non-GI illnesses to CDC has no effect on the Privacy Impact Assessment provided in the supporting statement for the information collection approved under OMB 0920-0821. All of the procedural and physical safeguards and access requirements remain the same.

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