Information Collection

Att 5_Domestic TB Manifest Template

IC 219570 under ICR 201601-0920-009 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 5_Domestic TB Manifest Template Order.doc	Other-WORD
Att 9_Order Cover Letter.doc Att 9_Order Cover Letter	IC Document
Att 10_IATA Passenger Manifest Information Request Form.pdf Att 10_Request Form for Passenger Contact Tracing	IC Document
Att 11_Informal manifest request template.doc Att 11_Informal Manifest Request Template	IC Document
Att 12_Receipt of manifest letter.doc Att 12_Recipt of Manifest Letter	IC Document

IC Title:

Agency IC Tracking Number:

16BM

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 70

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
Other-WORD			Att 5_Domestic TB Manifest Template Order.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation

FR Citation: 72 FR 7086

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 9_Order Cover Letter	Att 9_Order Cover Letter.doc	01/13/2016
Att 10_Request Form for Passenger Contact Tracing	Att 10_IATA Passenger Manifest Information Request Form.pdf	01/13/2016
Att 11_Informal Manifest Request Template	Att 11_Informal manifest request template.doc	01/13/2016
Att 12_Recipt of Manifest Letter	Att 12_Receipt of manifest letter.doc	01/13/2016

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