Information Collection

Risk Assessment for Travelers from Ebola outreak-affected countries

IC 213476 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Risk Assessment for Travelers from Ebola outreak-affected countries	Form and Instruction
Risk Assessment for Travelers from Ebola outreak-affecte Attachment C Ebola Risk Assessment clean.docx	Form and Instruction

IC Title:

Risk Assessment for Travelers from Ebola outreak-affected countries

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	None	Risk Assessment for Travelers from Ebola outreak-affected countries	Attachment C Ebola Risk Assessment clean.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 630

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	630	630
Annual IC Time Burden (Hours)	158	158
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.