Information Collection

State/Local General Outcome Reporting (Air)

IC 197945 under ICR 201802-0920-005 · OMB 0920-0900.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State/Local General Outcome Reporting (Air)	Form
General Contact Investigation Outcome Reporting Form - A Attachment G-General Contact Investigation Outcome Reporting Form Air tr....pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State/Local General Outcome Reporting (Air)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	n/a	General Contact Investigation Outcome Reporting Form - Air	Attachment G-General Contact Investigation Outcome Reporting Form Air tr....pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 0920-0171 Quarantine and Traveler Related Activities, Including Records for Cpmtact Tracing Investigation and Notification under 42 CFR Parts 70 and 71

FR Citation: 72 FR 70867

Number of Respondents: 34

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	34	22	12
Annual IC Time Burden (Hours)	3	2	1
Annual IC Cost Burden (Dollars)	106	106	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.