Emergency Submission for Active Monitoring of Travelers Coming from Ebola-affected Countries and Their Contacts Currently Residing in State, Territorial, and Local Jurisdictions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Weekly Active Monitoring - web	Form	New	Available
Daily Active Monitoring Tracking Report - web	Form	New	Available
Daily Active Monitoring Tracking Report - excel	Form	New	Available
SCTF AM-DAM EmergReq SS_B 20150330clean.docx	Supporting Statement B	Uploaded 2015-04-01	Available
SCTF AM-DAM EmergReq SS_A 20150519-trackedchanges.doc	Supporting Statement A	Uploaded 2015-05-20	Available
AttJ - NACCHO OMB Review clean.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttI - ASTHO OMB Review clean.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttH - CDC Ebola Assist Memo for State.pdf	Supplementary Document	Uploaded 2015-03-30	Available
AttB - Interim US Guid Ebola Monit Move.pdf	Supplementary Document	Uploaded 2015-03-30	Available
AttA - Authorizing Legislation.pdf	Supplementary Document	Uploaded 2015-03-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215921	Weekly Active Monitoring - web	Form	New
215920	Daily Direct Active Monitoring Tracking Report - email	Instruction	New
215919	Daily Active Monitoring Tracking Report - web	Form	New
215918	Daily Active Monitoring Tracking Report - excel	Form	New

ICR Details

OMB Control No: 0920-1066	ICR Reference No: 201503-0920-019
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15GG
Title: Emergency Submission for Active Monitoring of Travelers Coming from Ebola-affected Countries and Their Contacts Currently Residing in State, Territorial, and Local Jurisdictions
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 04/15/2015
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/29/2015
	Date Received in OIRA: 04/01/2015
Terms of Clearance: This ICR is approved for six months -- justification related to a public health need will need to be provided at that time for continued collection of the data. Once data collection stops, CDC should discontinue this ICR.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2015	6 Months From Approved
Responses	12,958	0	0
Time Burden (Hours)	1,181	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of this study is to allow CDC to effectively complement ongoing international and travel-related efforts at rapid case identification, contact tracing, and infection control of Ebola Virus Disease in partnership with key respondents who are 62 state and local health departments. The intended use of the data/information collected is to a assure that all persons returning from countries affected by the current Ebola outbreak are being actively monitored.

Emergency Justfication: Emergency clearance is requested to maintain and support direct active and active monitoring of travelers from Ebola-affected countries and healthcare workers who are treating patients with Ebola Virus Disease in the U.S. Disruption of this information collection could impact public health and healthcare providers.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Daily Active Monitoring Tracking Report - excel	none	Direct Active Monitoring Tracking Report
Daily Active Monitoring Tracking Report - web	none	Direct Active Monitoring Tracking Report - web
Daily Direct Active Monitoring Tracking Report - email
Weekly Active Monitoring - web	none	Weekly Active Monitoring Tracking Report

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	12,958	0	0	0	0	12,958
Annual Time Burden (Hours)	1,181	0	0	0	0	1,181
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $84,882

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/01/2015

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