Daily Active Monitoring Tracking Report - web

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

Documents and Forms

Document Name Document Type
Daily Active Monitoring Tracking Report - web Form
Direct Active Monitoring Tracking Report - web AttD-Daily DAM Recording High Some EVD Risk - Web.docx Form

Information Collection (IC) Details

IC Title:	Daily Active Monitoring Tracking Report - web	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Direct Active Monitoring Tracking Report - web	AttD-Daily DAM Recording High Some EVD Risk - Web.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,575	4,575
Annual IC Time Burden (Hours)	305	305
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.