Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances

Contact investigation Outcome Reporting Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0900 can be found here:

Documents and Forms

Document Name Document Type
Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances Form and Instruction
Ebola Exposure Questionnaire for Passengers of Other Com Attachment T ExposureQuestionnaire_OtherCommercialConveyance.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Ebola Exposure Questionnaire for Passengers of Other Commercial Conveyances	Attachment T ExposureQuestionnaire_OtherCommercialConveyance.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine- and Traveler-Related Activities	FR Citation: 72 FR 7086

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	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.