United States Traveler Health Declaration - French

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

Documents and Forms

Document Name Document Type
United States Traveler Health Declaration - French Form and Instruction
United States Traveler Health Declaration Attachment A2 United States Traveler Health Declaration - French.DOC Form and Instruction

Information Collection (IC) Details

IC Title:	United States Traveler Health Declaration - French	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 and Instruction	None	United States Traveler Health Declaration	Attachment A2 United States Traveler Health Declaration - French.DOC	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,125	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	9,125	9,125
Annual IC Time Burden (Hours)	2,281	2,281
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.