Information Collection

United States Travel Health Declaration (Arabic: Hard Copy)

IC 213997 under ICR 201411-0920-008 · OMB 0920-1031.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1031 United States Travel Health Declaration (Arabic: Hard Copy)	Form and Instruction
0920-1031 Attachment A3 DHS Form United States Traveler Health Dec Attachment A3 DHS Form United States Traveler Health Dec - Arabic.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-15FM

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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 A3 DHS Form United States Traveler Health Dec - Arabic	Attachment A3 DHS Form United States Traveler Health Dec - Arabic.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.