Information Collection

Exposure Risk Assessment for Travelers from Ebola-Affected Countries

IC 213021 under ICR 201502-0920-002 · OMB 0920-0821.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0821 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Exposure Risk Assessment for Travelers from Ebola-Affected Countries	Form
Risk Assessment for Travelers from Ebola-Affected Countr Ebola Risk Assessment Questions_1 pager 9-08-2014 rev final.docx	Form

IC Title:

Exposure Risk Assessment for Travelers from Ebola-Affected Countries

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	none	Risk Assessment for Travelers from Ebola-Affected Countries	Ebola Risk Assessment Questions_1 pager 9-08-2014 rev final.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-100	100
Annual IC Time Burden (Hours)	-5	5
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.