State/Local General Contact Reporting (Land)

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⚠️ Notice: This information collection may be referencing outdated material.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 General Contact Reporting (Land) Form
General Contact Investigation Outcome Reporting Form (La Attachment K - General Contact Investigation Outcome Reporting Form - La....docx Form

Information Collection (IC) Details

IC Title:	State/Local General Contact Reporting (Land)	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	n/a	General Contact Investigation Outcome Reporting Form (Land)	Attachment K - General Contact Investigation Outcome Reporting Form - La....docx		Yes	Yes	Fillable Fileable

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: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	47	47

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.