Information Collection Request

Emergency Submission to Supplement OMB Control Number 0920-0821 in the context of Screening Travelers for Ebola Risk

ICR 201411-0920-008 · OMB 0920-1031 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1031 Attachment A3 DHS Form United States Traveler Health Dec - Arabic Form and Instruction New Available
Form 0920-1031 Attachment A2 DHS Form United States Traveler Health Dec - French Form and Instruction New Available
Form 0920-1031 Attachment A1b DHS Form United States Traveler Health Dec - electronic portal screenshot Form and Instruction New Available
Form 0920-1031 Attachment A1a DHS Form United States Traveler Health Declaration - English Form and Instruction New Available
Form 0920-1031 Attachment A1c DHS Form United States Traveler Health Declaration - fillable PDF Form and Instruction New Available
Form 0920-1031 Attachment B2 CDC Form EbolaRiskAssessment - French Form and Instruction New Available
Form 0920-1031 Attachment B1 CDC Form Ebola Risk Assessment - English Form and Instruction New Available
Risk Assessment for Travelers from Ebola outreak-affected countries Form and Instruction Unchanged Available
United States Traveler Health Declaration Form and Instruction Unchanged Available
United States Traveler Health Declaration - English Form and Instruction Unchanged Available
Non-substantive Change 0920-1031 Em Change Supplment to 0821_Entry Screening - final.docx Justification for No Material/Nonsubstantive Change Uploaded 2014-11-19 Available
USCODE-2009-title42-chap6A-subchapII-partG.pdf Supplementary Document Uploaded 2014-10-10 Available
Attachment B DHS JobAid.docx Supplementary Document Uploaded 2014-10-10 Available
0920-0821 Emergency Request Entry Screening Part B.docx Supporting Statement B Uploaded 2014-10-10 Available
0920-0821 Emergency Request Entry Screening Part A.doc Supporting Statement A Uploaded 2014-10-10 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
213997 United States Travel Health Declaration (Arabic: Hard Copy) Form and Instruction NewAttachment A3 DHS Form United States Traveler Health Dec - Arabic
213996 United States Travel Health Declaration (French, Hard copy) Form and Instruction NewAttachment A2 DHS Form United States Traveler Health Dec - French
213995 United States Travel Health Declaration (English:hard copy, fillable PDF, electonic Portal) Form and Instruction NewAttachment A1b DHS Form United States Traveler Health Dec - electronic portal screenshot
213995 United States Travel Health Declaration (English:hard copy, fillable PDF, electonic Portal) Form and Instruction NewAttachment A1a DHS Form United States Traveler Health Declaration - English
213995 United States Travel Health Declaration (English:hard copy, fillable PDF, electonic Portal) Form and Instruction NewAttachment A1c DHS Form United States Traveler Health Declaration - fillable PDF
213994 Ebola Risk Assessment for Travelers from Outbreak-affected Countries (French) Form and Instruction NewAttachment B2 CDC Form EbolaRiskAssessment - French
213992 Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English) Form and Instruction NewAttachment B1 CDC Form Ebola Risk Assessment - English
213476 Risk Assessment for Travelers from Ebola outreak-affected countries Form and Instruction UnchangedRisk Assessment for Travelers from Ebola outreak-affected countries
213475 United States Traveler Health Declaration - French Form and Instruction UnchangedUnited States Traveler Health Declaration
213474 United States Traveler Health Declaration - English Form and Instruction UnchangedUnited States Traveler Health Declaration - English

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
04/30/2015 04/30/2015 04/30/2015
88,420 0 55,380
22,106 0 13,845
0 0 0





Reginfo record details
8
table that charts list of burden
IC Title Form No. Form Name
Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English) 0920-1031
Ebola Risk Assessment for Travelers from Outbreak-affected Countries (French) 0920-1031
Risk Assessment for Travelers from Ebola outreak-affected countries None
United States Travel Health Declaration (Arabic: Hard Copy) 0920-1031
United States Travel Health Declaration (English:hard copy, fillable PDF, electonic Portal) 0920-1031, 0920-1031, 0920-1031 ,   ,  
United States Travel Health Declaration (French, Hard copy) 0920-1031
United States Traveler Health Declaration - English None
United States Traveler Health Declaration - French None

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 88,420 55,380 0 33,040 0 0
Annual Time Burden (Hours) 22,106 13,845 0 8,261 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No