OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

ICR 201601-0920-011 · OMB 0920-0821 · Public filing

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Ebola Entry Screening Risk Assessment Form - Arabic Form and Instruction Removed Available
Ebola Entry Screening Risk Assessment Form - French Form and Instruction Removed Available
Ebola Entry Screening Risk Assessment Form - English Form and Instruction Removed Available
Ebola Entry Screening Risk Assessment Form - Arabic Form and Instruction Removed Available
Ebola Entry Screening Risk Assessment Form - French Form and Instruction Removed Available
Ebola Entry Screening Risk Assessment Form - English Form and Instruction Removed Available
United States Traveler Health Declaration - Arabic Translation Guide Form and Instruction Removed Available
United States Traveler Health Declaration - French Translation Guide Form and Instruction Removed Available
United States Health Declaration - English/PDF Form and Instruction Removed Available
United States Traveler Health Declaration - English/Portal Form and Instruction Removed Available
United States Traveler Health Declaration - English/Hard Copy Form and Instruction Removed Available
Air Travel Illness or Death Investigation Form Modified Available
Land Travel Illness or Death Investigation Form Modified Available
Maritime Conveyance Illness or Death Investigation Form 0821_0134 Form and Instruction Modified Available
0920-0821 Revision Part B 02182016.docx Supporting Statement B Uploaded 2016-02-22 Available
0920-0821 Revision Part A 02182016.doc Supporting Statement A Uploaded 2016-02-22 Available
Attachment G Non-research Determination.pdf Supplementary Document Uploaded 2016-02-22 Available
Attachment B 60 Day FRN 0920-0821.pdf Supplementary Document Uploaded 2016-02-22 Available
Attachment A3 CFR-2013-title42-vol1-part71.pdf Supplementary Document Uploaded 2015-02-06 Available
Attachment A2 CFR-2013-title42-vol1-part70.pdf Supplementary Document Uploaded 2015-02-06 Available
Attachment A1 USCODE-2009-title42-chap6A-subchapII-partG.PDF Supplementary Document Uploaded 2015-02-06 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
214908 Ebola Entry Screening Risk Assessment (Ill Traveler Interview) Form and Instruction RemovedEbola Entry Screening Risk Assessment Form - Arabic
214908 Ebola Entry Screening Risk Assessment (Ill Traveler Interview) Form and Instruction RemovedEbola Entry Screening Risk Assessment Form - French
214908 Ebola Entry Screening Risk Assessment (Ill Traveler Interview) Form and Instruction RemovedEbola Entry Screening Risk Assessment Form - English
214903 IVR Active Monitoring Survey - ARABIC (for translation service) Other-IVR Telephone Survey Script (Limited number - English for Removed
214902 IVR Active Monitoring Survey - FRENCH Other-IVR Telephone Survey Script - French Removed
214901 IVR Active Monitoring Survey - ENGLISH Other-IVR Telephone Survey Script - English Removed
214898 Ebola Entry Screening Risk Assessment - ARABIC Form and Instruction RemovedEbola Entry Screening Risk Assessment Form - Arabic
214896 Ebola Entry Screening Risk Assessment - FRENCH Form and Instruction RemovedEbola Entry Screening Risk Assessment Form - French
214895 Ebola Entry Screening Risk Assessment - ENGLISH Form and Instruction RemovedEbola Entry Screening Risk Assessment Form - English
214893 United States Traveler Health Declaration - ARABIC Form and Instruction RemovedUnited States Traveler Health Declaration - Arabic Translation Guide
214890 United States Traveler Health Declaration - FRENCH Form and Instruction RemovedUnited States Traveler Health Declaration - French Translation Guide
214888 United States Traveler Health Declaration - ENGLISH Form and Instruction RemovedUnited States Health Declaration - English/PDF
214888 United States Traveler Health Declaration - ENGLISH Form and Instruction RemovedUnited States Traveler Health Declaration - English/Portal
214888 United States Traveler Health Declaration - ENGLISH Form and Instruction RemovedUnited States Traveler Health Declaration - English/Hard Copy
188000 Air Travel Illness or Death Investigation Form ModifiedAir Travel Illness or Death Investigation
187999 Land Travel Illness or Death Investigation Form ModifiedLand Travel Illness or Death Investigation
187997 International Maritime Conveyance Illness or Death Investigation Form Form and Instruction ModifiedMaritime Conveyance Illness or Death Investigation Form 0821_0134

ICR Details

Record metadata
OMB Control No0920-0821