State/Local Rubella Outcome Reporting (Air)

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⚠️ Notice: This information collection may be referencing outdated material.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
State/Local Rubella Outcome Reporting (Air) Form
Rubella Contact Investigation Outcome Reporting Form - A Attachment J -Rubella Outcome Reporting Form Air travel.pdf Form

Information Collection (IC) Details

IC Title:	State/Local Rubella 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	Rubella Contact Investigation Outcome Reporting Form - Air	Attachment J -Rubella Outcome Reporting Form Air travel.pdf		Yes	Yes	Fillable Fileable

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, and Notification under 42 CFR 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 27	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	27	-68	95
Annual IC Time Burden (Hours)	2	-6	8
Annual IC Cost Burden (Dollars)	84	84	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.