Information Collection

Gastrointestinal Illness Reports 24 and 4 hours before Arrival (VSP) Title 71.21. (c)

IC 202073 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⚠️ Notice: This information collection may be referencing outdated material.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 2 Gastrointestinal Illness Reports 24 and 4 hours before Arrival (VSP) Title 71.21. (c)	Form
2 Maritime Illness and Death Reporting System--Gastrointes Attachment 6a 71.21c Gastrointestinal illnesses reports MIDRS screenshot.pdf	Form
Attachment 5 Reportable Medical Conditions.docx Attachment 5 Reportable Medical Conditions	IC Document

IC Title:

Gastrointestinal Illness Reports 24 and 4 hours before Arrival (VSP) Title 71.21. (c)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR Subpart C (To search for a specific CFR, visit the Code of Federal Regulations.)

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	2	Maritime Illness and Death Reporting System--Gastrointestinal Illness Report	Attachment 6a 71.21c Gastrointestinal illnesses reports MIDRS screenshot.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Quarantine and Traveler-Related Activities, Including Records for Tracing, Investigation and Notification under 42 CFR Parts 70 and 71

FR Citation: 72 FR 70867

Number of Respondents: 17,000

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	17,000	17,000
Annual IC Time Burden (Hours)	850	850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5 Reportable Medical Conditions	Attachment 5 Reportable Medical Conditions.docx	04/23/2012

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