Information Collection

United States Traveler Health Declaration - French

IC 213475 under ICR 201410-0920-017 · OMB 0920-1031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1031 can be found here:

Documents and Forms

Document Name Document Type
United States Traveler Health Declaration - French Form and Instruction
United States Traveler Health Declaration Attachment A2 United States Traveler Health Declaration - French.DOC Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	United States Traveler Health Declaration - French	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	United States Traveler Health Declaration	Attachment A2 United States Traveler Health Declaration - French.DOC	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,125	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,125	9,125
Annual IC Time Burden (Hours)	2,281	2,281
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.