Exposure Risk Assessment for Travelers from Ebola-Affected Countries

Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.