Information Collection

42 CFR 70.4 Report of Communcable Disease While in Interstate Travel by Master of Vessel

IC 205723 under ICR 201512-0920-001 · OMB 0920-0488.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0488 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
42 CFR 70.4 Report of Communcable Disease While in Interstate Travel by Master of Vessel	Form
Report by Master or Person in Charge Attachment 6 Master of Vessel or Conveyance Illness Report 101712 (1).doc	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

42 CFR 70.4 Report of Communcable Disease While in Interstate Travel by Master of Vessel

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	Report by Master or Person in Charge	Attachment 6 Master of Vessel or Conveyance Illness Report 101712 (1).doc		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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 42CFR Parts 70 and 71 70

FR Citation: 72 FR 70867

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

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	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	200	0	200
Annual IC Time Burden (Hours)	23	-27	50
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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