Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English)

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
Form 0920-1031 Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English) Form and Instruction
0920-1031 Attachment B1 CDC Form Ebola Risk Assessment - English Attachment B1 CDC Form Ebola Risk Assessment - English.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ebola Risk Assessment for Travelers from Outbreak-affected Countries (English)	Agency IC Tracking Number:	0920-15FM

Is this a Common Form? No		IC Status: New

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	0920-1031	Attachment B1 CDC Form Ebola Risk Assessment - English	Attachment B1 CDC Form Ebola Risk Assessment - English.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 304	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	304	304
Annual IC Time Burden (Hours)	76	76
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.