Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Passenger Locator Form - domestic flights	Form	New	Repair queued
Passenger Locator Form - limited onboard exposure int'l flights	Form	New	Available
Passenger Locator Form - outbreak of PH significance int'l flights	Form	New	Repair queued
Attachment 13 System of Record Notice.pdf	Supplementary Document	Uploaded 2017-05-03	Repair queued
Attachment 12 Approval for Removal of Expiration Date.pdf	Supplementary Document	Uploaded 2016-11-02	Repair queued
Attachment 10 Receipt of manifest letter.doc	Supplementary Document	Uploaded 2016-11-02	Repair queued
Attachment 8 IATA Passenger Manifest Information Request Form.pdf	Supplementary Document	Uploaded 2016-11-02	Available
Attachment 7 Order Cover Letter.doc	Supplementary Document	Uploaded 2016-11-02	Repair queued
Attachment 4 CDC Nonresearch determination Letter.pdf	Supplementary Document	Uploaded 2016-10-31	Available
Attachment 3 QARS Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2016-10-31	Repair queued
Attach 2 PLF 60 day 9.2.16.pdf	Supplementary Document	Uploaded 2016-10-31	Available
Attachment 1C 42 CFR part 70.pdf	Supplementary Document	Uploaded 2016-10-31	Available
Attachment 1B 42 CFR part 71.pdf	Supplementary Document	Uploaded 2016-10-31	Available
Attachment 1A Section 361 of the Public Health Service Act (42 USC 264).docx	Supplementary Document	Uploaded 2016-10-31	Repair queued
0920-XXXX_Domestic Manifest PLF Supporting Statement Part B.doc	Supporting Statement B	Uploaded 2016-10-31	Available
Domestic Manifest PLF Supporting Statement Part A 04242017.doc	Supporting Statement A	Uploaded 2017-05-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224286	Passenger Locator Form - domestic flights	Form	New
224285	Passenger Locator Form - limited onboard exposure int'l flights	Form	New
224284	Passenger Locator Form - outbreak of PH significance int'l flights	Form	New
224253	Domestic non-TB Manifest Template and Informal Manifest Request	Instruction	New
224252	Domestic TB Manifest Template or Informal Manifest Request	Instruction	New

ICR Details

OMB Control No: 0920-1181	ICR Reference No: 201610-0920-015
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16BBS
Title: Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/08/2017
	Date Received in OIRA: 11/08/2016
Terms of Clearance: Approved consistent with the understanding that an individual's refusal to be screened or to complete the passenger locator form will not directly result in that individual’s quarantine, isolation, or conditional release. However, if sufficient facts and circumstances exist that would lead a public health officer to reasonably suspect that the individual is infected with a quarantinable communicable disease in its qualifying stage, then that individual may be issued a Federal order for quarantine, isolation, or conditional surveillance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved
Responses	2,701,629	0	0
Time Burden (Hours)	225,308	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection ensures that, consistent with the authorities in the Public Health Service Act and in Code of Federal Regulations (CFR), CDC can collect conveyance, passenger and crew member manifest information (manifests) and Passenger Locator Forms (PLF) in the event an individual with a confirmed or suspected case of a communicable disease is known to have traveled on an interstate flight while infectious or potentially infectious and presented a risk of spread to other passengers or crew. This is collected so CDC can initiate the process of contact tracing or provision of other public health follow up to prevent further disease spread.

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Authorizing Statute(s): Statute at Large: 42 Stat. 70 Name of Statute: Interstate Quarantine
   Statute at Large: 42 Stat. 71 Name of Statute: Foreign Quarantine
   US Code: 42 USC 264 Name of Law: Public Health and Welfare
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 60702	09/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 78165	11/07/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Domestic TB Manifest Template or Informal Manifest Request
Domestic non-TB Manifest Template and Informal Manifest Request
Passenger Locator Form - outbreak of PH significance int'l flights	none	Passenger Locator Form
Passenger Locator Form - limited onboard exposure int'l flights	none	Passenger Locator Form
Passenger Locator Form - domestic flights	none	Passenger Locator Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,701,629	0	0	2,701,629	0	0
Annual Time Burden (Hours)	225,308	0	0	225,308	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a request for approval of an existing collection without an OMB number.

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Annual Cost to Federal Government: $355,282

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/08/2016

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