Risk Assessment for Travelers from Ebola outreak-affected countries

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
Risk Assessment for Travelers from Ebola outreak-affected countries Form and Instruction
Risk Assessment for Travelers from Ebola outreak-affecte Attachment C Ebola Risk Assessment clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Risk Assessment for Travelers from Ebola outreak-affected countries	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	Risk Assessment for Travelers from Ebola outreak-affected countries	Attachment C Ebola Risk Assessment clean.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 630	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	630	630
Annual IC Time Burden (Hours)	158	158
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.