Information Collection

Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries

IC 215587 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Management of Fever in Travelers from Ebola Affected and Ebola Non-affected Malaria Endemic Countries	Form
Assessment for Health Depts Attachment A_Ebola_Malaria_Assessment_Health Department.docx	Form
Assessment for Health Facilities Attachment B_Ebola_Malaria_Assessment_Health Facility.docx	Form
0920 1026_ Malaria_Ebola_GenIC_final.docx Request for Approval	IC Document
Attachment C_PhoneScripts.docx Telephone Script	IC Document
Attachment D_Population Diagram.docx Population Diagram	IC Document

IC Title:

Agency IC Tracking Number:

15SY

IC Status: New

Obligation to Respond: Voluntary

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	Assessment for Health Depts	Attachment A_Ebola_Malaria_Assessment_Health Department.docx		No		Paper Only
Form	none	Assessment for Health Facilities	Attachment B_Ebola_Malaria_Assessment_Health Facility.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 264

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	264	264
Annual IC Time Burden (Hours)	61	61
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	0920 1026_ Malaria_Ebola_GenIC_final.docx	03/06/2015
Telephone Script	Attachment C_PhoneScripts.docx	03/06/2015
Population Diagram	Attachment D_Population Diagram.docx	03/06/2015

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