OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

United States Travel Health Declaration (English:hard copy, fillable PDF, electonic Portal)

IC 213995 under ICR 201411-0920-008 · OMB 0920-1031.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 0920-1031
United States Travel Health Declaration (English:hard copy, fillable PDF, electonic Portal)		 Form and Instruction
0920-1031 Attachment A1a DHS Form United States Traveler Health De
Attachment A1a DHS Form United States Traveler Health Declaration - English.doc 		Form and Instruction
0920-1031 Attachment A1b DHS Form United States Traveler Health De
Attachment A1b DHS Form United States Traveler Health Dec - electronic portal screenshot.png 		Form and Instruction
0920-1031 Attachment A1c DHS Form United States Traveler Health De
Attachment A1c DHS Form United States Traveler Health Declaration - fillable PDF.pdf 		Form and Instruction
Attachment A1b DHS Form United States Traveler Health Dec - electronic portal word ver.docx
Attachment A1b DHS Form United States Traveler Health Dec - electronic portal word ver		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1031 Attachment A1c DHS Form United States Traveler Health Declaration - fillable PDF Attachment A1c DHS Form United States Traveler Health Declaration - fillable PDF.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-1031 Attachment A1a DHS Form United States Traveler Health Declaration - English Attachment A1a DHS Form United States Traveler Health Declaration - English.doc Yes Yes Fillable Printable
Form and Instruction 0920-1031 Attachment A1b DHS Form United States Traveler Health Dec - electronic portal screenshot Attachment A1b DHS Form United States Traveler Health Dec - electronic portal screenshot.png Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 22,663 0 22,663 0 0 0
Annual IC Time Burden (Hours) 5,666 0 5,666 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Attachment A1b DHS Form United States Traveler Health Dec - electronic portal word ver Attachment A1b DHS Form United States Traveler Health Dec - electronic portal word ver.docx 11/19/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.