Weekly Active Monitoring - 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
Weekly Active Monitoring - web Form
Weekly Active Monitoring Tracking Report AttF - Weekly AM Report Low not zero EVD Risk - Web Form.docx Form
AttE-Weekly AM Report Word 051415.docx Weekly Active Monitoring Report - word IC Document
AttG - Weekly Notification Email-revise05192015.docx Weekly Notification Email IC Document

Information Collection (IC) Details

IC Title:	Weekly Active Monitoring - 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	Weekly Active Monitoring Tracking Report	AttF - Weekly AM Report Low not zero EVD Risk - Web Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 62	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	1,612	1,612
Annual IC Time Burden (Hours)	349	349
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Weekly Active Monitoring Report - word	AttE-Weekly AM Report Word 051415.docx	05/20/2015
Weekly Notification Email	AttG - Weekly Notification Email-revise05192015.docx	05/20/2015

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