Information Collection

Att J_42CFR71.21(c )_(MIDRS) Gastrointestinal Illness Report

IC 202073 under ICR 201611-0920-006 · OMB 0920-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 42CFR71.21(c ) Att J_42CFR71.21(c )_(MIDRS) Gastrointestinal Illness Report	Form
42CFR71.21(c ) (MIDRS) Gastrointestinal Illness Report Att J_42 CFR 71.21 (c ) (MIDRS) Gastrointestinal Illnesses reports.pdf	Form

IC Title:

Att J_42CFR71.21(c )_(MIDRS) Gastrointestinal Illness Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR Subpart C (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Form	42CFR71.21(c )	(MIDRS) Gastrointestinal Illness Report	Att J_42 CFR 71.21 (c ) (MIDRS) Gastrointestinal Illnesses reports.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Quarantine and Traveler-Related Activities, Including Records for Tracing, Investigation and Notification under 42 CFR Parts 70 and 71

FR Citation: 72 FR 70867

Number of Respondents: 17,000

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
	Approved	Previously Approved
Annual Number of Responses for this IC	17,000	17,000
Annual IC Time Burden (Hours)	850	850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.