International Maritime Illness or Death Investigation

Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing

OMB: 0920-0821

IC ID: 187997

Information Collection (IC) Details

View Information Collection (IC)

International Maritime Illness or Death Investigation
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0821 Attachment A Maritime investigation form Attachment A Maritime investigation form_June22 2012.docx Yes Yes Fillable Printable

Health Public Health Monitoring

Quarantine and Traveler Related Activities, including Records for Contact Tracing Investigation and Notification  72 FR 70867

1,873 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,873 0 0 0 0 1,873
Annual IC Time Burden (Hours) 156 0 0 0 0 156
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment B 71 21a Other illness reports MIDRS screenshot Attachment B 71 21a Other illness reports MIDRS screenshot.pdf 03/29/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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