United States Traveler Health Declaration - ENGLISH

Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing

OMB: 0920-0821

IC ID: 214888

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

United States Traveler Health Declaration - ENGLISH
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None United States Traveler Health Declaration - English/Hard Copy Attachment F1a 2015 01 23 Health Declaration clean.doc None Yes Yes Fillable Fileable
Form and Instruction None United States Traveler Health Declaration - English/Portal Attachment F1b United States Traveler Health Declaration - Portal.png None Yes Yes Fillable Fileable
Form and Instruction None United States Health Declaration - English/PDF Attachment F1c 2015 01 12 Health Declaration - Fillable PDF.PDF None Yes Yes Fillable Fileable

Health Public Health Monitoring

Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation  72 FR 7086

49,238 0
   
Individuals or Households
 
   99 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -49,238 0 0 49,238
Annual IC Time Burden (Hours) 0 0 -12,310 0 0 12,310
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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