Passenger Locator Form used in a outbreak of public health significance

Foreign Quarantine Regulations (42CFR71)

⚠️ Notice: This information collection may be referencing outdated material.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 4 Passenger Locator Form used in a outbreak of public health significance Form and Instruction
4 Public Health Passenger Locator Form Attachment 4 Passenger Locator Form 2012.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Passenger Locator Form used in a outbreak of public health significance	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Public Health Passenger Locator Form	Attachment 4 Passenger Locator Form 2012.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title: Quarantine and Traveler-Related Activities, Including Records for Contact, Tracing, Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 2,700,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-2,700,000	2,700,000
Annual IC Time Burden (Hours)	-225,000	225,000
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.