Information Collection

Ebola Entry Screening Risk Assessment - ENGLISH

IC 214895 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⚠️ Notice: This information collection may be referencing outdated material.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
Ebola Entry Screening Risk Assessment - ENGLISH	Form and Instruction
Ebola Entry Screening Risk Assessment Form - English Attachment G1 CDC Form Ebola Risk Assessment clean.docx	Form and Instruction

IC Title:

Ebola Entry Screening Risk Assessment - ENGLISH

Agency IC Tracking Number:

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	None	Ebola Entry Screening Risk Assessment Form - English	Attachment G1 CDC Form Ebola Risk Assessment clean.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation

FR Citation: 72 FR 7086

Number of Respondents: 3,447

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	3,447	3,447
Annual IC Time Burden (Hours)	862	862
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.