OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

2014E003XXX_MERS-CoV_GA

IC 211682 under ICR 201504-0920-005 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2014E003XXX_MERS-CoV_GA	Form
Questionnaire for Passengers and Crew Appendix A. Telephone Survey.docx	Form
Follow-up Questionnaire for Asymptomatic Passengers and Appendix B. Follow-up Telephone Survey.docx	Form
2014003XXX_MERS-CoV_GA.docx Request for Approval	IC Document
Request for CDC Assistance.msg Invitation for Assistance	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

2014E003XXX_MERS-CoV_GA

Agency IC Tracking Number:

14AET

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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	none	Questionnaire for Passengers and Crew	Appendix A. Telephone Survey.docx		No		Paper Only
Form	none	Follow-up Questionnaire for Asymptomatic Passengers and Crew	Appendix B. Follow-up Telephone Survey.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 186

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	186	0	0	0	0	186
Annual IC Time Burden (Hours)	40	0	0	0	0	40
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	2014003XXX_MERS-CoV_GA.docx	05/22/2014
Invitation for Assistance	Request for CDC Assistance.msg	05/22/2014

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