Air Travel Illness or Death Investigation Form

Foreign Quarantine Regulations (42CFR71)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 0920-0134 Air Travel Illness or Death Investigation Form Form and Instruction
0920-0134 Air Travel Illness or Death Investigation Form Attachment C Air Travel Illness or Death Investigation Form final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Air Travel Illness or Death Investigation Form	Agency IC Tracking Number:	0920-0134

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 70 42 CFR 71

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0134	Air Travel Illness or Death Investigation Form	Attachment C Air Travel Illness or Death Investigation Form final.docx	NA	No		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	FR Citation: 72 FR 786

Number of Respondents: 1,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	142	142
Annual IC Cost Burden (Dollars)	3,456	3,456

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.