Script Introduction and Confirmation

Emergency Submission to Supplement OMB Control Number 0920-0900 in Context of Contact Investigations Associated with Ebola and Travel

Documents and Forms

Document Name Document Type
Script Introduction and Confirmation Form
Introduction and confirmation Attachment A Script_Introduction and Confirmation.docx Form

Information Collection (IC) Details

IC Title:	Script Introduction and Confirmation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	none	Introduction and confirmation	Attachment A Script_Introduction and Confirmation.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0171 Quarantine and Travler Related Activities, Including Records for Contact tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 25,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	2,083	2,083
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.