Information Collection

Locator Form used for Reporting of an Ill Passenger(s) (Airport)

IC 189695 under ICR 201304-0920-012 · OMB 0920-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Locator Form used for Reporting of an Ill Passenger(s) (Airport)	Form
4 Public Health Passenger Locator Form Attachment 4 Passenger Locator Form 2012.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Locator Form used for Reporting of an Ill Passenger(s) (Airport)

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	4	Public Health Passenger Locator Form	Attachment 4 Passenger Locator Form 2012.pdf		No	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

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: 800

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	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.