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

Foreign Quarantine Regulations

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 71.21(c) 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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	71.21(c)	Attachment J 71.21c Gastrointestinal illnesses reports MIDRS screenshot	Attachment J 71.21c Gastrointestinal illnesses reports MIDRS screenshot.pdf		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 %

	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

Title	Document	Date Uploaded
Attachment 5 Reportable Medical Conditions	Attachment 5 Reportable Medical Conditions.docx	04/23/2012

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