Emergency Submission to Supplement OMB Control Number 0920-0821 in the Context of Active Monitoring of Travelers Coming from Sierra Leone, Liberia, and Guinea

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Active Monitoring Survey - French	Form and Instruction	New	Available
Active Monitoring Survey	Form and Instruction	New	Available
Attachment B - CARE wallet card.pdf	Supplementary Document	Uploaded 2014-10-29	Repair queued
USCODE-2009-title42-chap6A-subchapII-partG.PDF	Supplementary Document	Uploaded 2014-10-29	Available
0920-0821 Emergency Request Active Monitoring Part B.docx	Supporting Statement B	Uploaded 2014-10-29	Available
0920-0821 Emergency Request Active Monitoring Part A 10-29-14.doc	Supporting Statement A	Uploaded 2014-10-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213669	Active Monitoring Survey - French	Form and Instruction	New
213668	Active Monitoring Survey	Form and Instruction	New

ICR Details

OMB Control No: 0920-1034	ICR Reference No: 201410-0920-033
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15CU
Title: Emergency Submission to Supplement OMB Control Number 0920-0821 in the Context of Active Monitoring of Travelers Coming from Sierra Leone, Liberia, and Guinea
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/31/2014
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/30/2014
	Date Received in OIRA: 10/30/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	6 Months From Approved
Responses	574,854	0	0
Time Burden (Hours)	38,324	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention (CDC) has been tasked to support state health departments as they engage in active monitoring of travelers arriving at U.S. airports from countries currently affected by the Ebola outbreak. This data collection will be conducted via a survey administered either through Interactive Voice Response (IVR) phone system or by a live person and will ask travelers if they have developed a fever or any other symptoms potentially indicative of Ebola exposure.

Emergency Justfication: The Centers for Disease Control and Prevention (CDC) has been tasked to support state health departments as they engage in active monitoring of travelers arriving at U.S. airports from countries currently affected by the Ebola outbreak. This data collection will be conducted via a survey administered either through Interactive Voice Response (IVR) phone system or by a live person and will ask travelers if they have developed a fever or any other symptoms potentially indicative of Ebola exposure.

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Authorizing Statute(s): US Code: 42 USC 264G Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Active Monitoring Survey	none	Active Monitoring Survey - English
Active Monitoring Survey - French	none	Active Monitoring Survey - French

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	574,854	0	0	574,854	0	0
Annual Time Burden (Hours)	38,324	0	0	38,324	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is an emergency request to support state health departments as they engage in active monitoring of travelers arriving at U.S. airports from countries currently affected by the Ebola outbreak

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Annual Cost to Federal Government: $98,387

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/30/2014

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