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United States Traveler Health Declaration - FRENCH
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
OMB: 0920-0821
IC ID: 214890
OMB.report
HHS/CDC
OMB 0920-0821
ICR 201601-0920-011
IC 214890
( )
Documents and Forms
Document Name
Document Type
United States Traveler Health Declaration - FRENCH
Form and Instruction
United States Traveler Health Declaration - French Trans
Attachment F2 United States Health Dec Trans Guide French.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
United States Traveler Health Declaration - FRENCH
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Removed
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
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 - French Translation Guide
Attachment F2 United States Health Dec Trans Guide French.docx
None
No
Paper Only
Federal Enterprise Architecture Business Reference Module
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:
1,586
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
-1,586
0
0
1,586
Annual IC Time Burden (Hours)
0
0
-397
0
0
397
Annual IC Cost Burden (Dollars)
0
0
0
0
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.