Information Collection

71.21 (a) Radio Report of Death/Illness Report from Ships

IC 6646 under ICR 201305-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
71.21 (a) Radio Report of Death/Illness Report from Ships	Form
Maritime Conveyance Cumulative Influenza-Like Illness Fo Attachment A Maritime Cumulative ILI Form.pdf	Form
Maritime Conveyance Illness or Death Investigation Form Attachment B Maritime investigation form_June22 2012.docx	Form

IC Title:

71.21 (a) Radio Report of Death/Illness Report from Ships

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	none	Maritime Conveyance Cumulative Influenza-Like Illness Form	Attachment A Maritime Cumulative ILI Form.pdf		Yes	Yes	Fillable Fileable
Form	none	Maritime Conveyance Illness or Death Investigation Form	Attachment B Maritime investigation form_June22 2012.docx		Yes	Yes	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: 2,000

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
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
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.