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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
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

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United States Travel Health Declaration (English:hard copy, fillable PDF, electonic Portal) 0920-15FM
 
No New
 
Voluntary
 

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

Health Public Health Monitoring

 

22,663 0
   
Individuals or Households
 
   0 %

  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

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.