Active Monitoring Survey

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

Documents and Forms

Document Name Document Type
Active Monitoring Survey Form and Instruction
Active Monitoring Survey - English Attachment A- IVR Script for Active Monitoring _OMB.10-28.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Active Monitoring Survey	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	Active Monitoring Survey - English	Attachment A- IVR Script for Active Monitoring _OMB.10-28.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine and Traveler Related Activities	FR Citation: 72 FR 70867

Number of Respondents: 22,812	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	479,052	479,052
Annual IC Time Burden (Hours)	31,937	31,937
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.