Flight Crew Assessment

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
Flight Crew Assessment Form
Crew Assessment Attachment C Ebola Airline Exposure Assessment Flight Crew_10-15-2014.doc Form

Information Collection (IC) Details

IC Title:	Flight Crew Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	Crew Assessment	Attachment C Ebola Airline Exposure Assessment Flight Crew_10-15-2014.doc		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

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

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,400	2,400
Annual IC Time Burden (Hours)	-800	800
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.