Information Collection

42 CFR 70.4 Copy of Material submitted to Health Authority

IC 205724 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
42 CFR 70.4 Copy of Material submitted to Health Authority Form
Restriction on Travel of Persons Attachment 4 Master of Vessel or Conveyance Illness Report 101712.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	42 CFR 70.4 Copy of Material submitted to Health Authority	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	none	Restriction on Travel of Persons	Attachment 4 Master of Vessel or Conveyance Illness Report 101712.doc		Yes	Yes	Fillable Fileable

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	FR Citation: 72 FR 70867

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-200	200
Annual IC Time Burden (Hours)	-50	50
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.