Information Collection

Gastrointestinal Illness Reports 24 and 4 hours before Arrival (VSP) Title 71.21. (c)

IC 202073 under ICR 201502-0920-010 · OMB 0920-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 71.21(c) Attachment J 71.21c Gastrointestinal illnesses reports MIDRS screenshot Gastrointestinal Illness Reports 24 and 4 hours before Arrival (VSP) Title 71.21. (c)	Form and Instruction
71.21(c) Attachment J 71.21c Gastrointestinal illnesses reports M Attachment J 71.21c Gastrointestinal illnesses reports MIDRS screenshot.pdf	Form and Instruction
Attachment 5 Reportable Medical Conditions.docx Attachment 5 Reportable Medical Conditions	IC Document

IC Title:

Gastrointestinal Illness Reports 24 and 4 hours before Arrival (VSP) Title 71.21. (c)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR Subpart C (To search for a specific CFR, visit the Code of Federal Regulations.)

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	71.21(c)				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Quarantine and Traveler-Related Activities, Including Records for Tracing, Investigation and Notification under 42 CFR Parts 70 and 71

FR Citation: 72 FR 70867

Number of Respondents: 17,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	17,000	17,000
Annual IC Time Burden (Hours)	850	850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5 Reportable Medical Conditions		04/23/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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