Information Collection Request

2019 Novel Coronavirus Airport Entry Questionnaires

ICR 202001-0920-020 · OMB 0920-1287 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-20HF COVID-2019 Air Traveler Illness and Death Investigation Form Form and Instruction New Repair queued
Form 0920-20HF United States Travel Health Declaration for Repatriation from Ship Form and Instruction New Repair queued
Form 0920-20HF Supplemental 2019 Questionnaire Form and Instruction New Repair queued
Form 0920-20HF COVID-2019 Referral Slip Form and Instruction New Repair queued
Form 0920-20HF Preboarding Health Screen Form and Instruction New Available
Form 0920-20HF United States Travel Health Declaration for Repatriation Form and Instruction New Available
Form 0920-20HF United States Traveler Health Declaration Form and Instruction New Repair queued
Attachment L Wuhan Airport Entry Risk Assessment IRB.pdf Supplementary Document Uploaded 2020-03-09 Available
Attachment A2 42 CFR part 71.docx Supplementary Document Uploaded 2020-03-09 Available
Attachment A1 42 USC 264.pdf Supplementary Document Uploaded 2020-03-09 Available
SSB Emergency Clearance COVID-2019 Entry Risk Assessmentl-3.5.2020-Final-CLEAN.docx Supporting Statement B Uploaded 2020-03-09 Available
SSA Emergency Clearance COVID-2019 Entry Risk Assessment_3.5.2020_Final-CLEAN.docx Supporting Statement A Uploaded 2020-03-09 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
240643 COVID-2019 Air Traveler Illness and Death Investigation Form Form and Instruction New
240642 United States Travel Health Declaration for Repatriation from Ship Form and Instruction New
239872 Daily Sympton Check Other-Recorded New
239871 Supplemental 2019 Questionnaire Form and Instruction New
239870 COVID-2019 Referral Slip Form and Instruction New
239869 Preboarding Health Screen Form and Instruction New
239868 United States Travel Health Declaration for Repatriation Form and Instruction New
239867 United States Traveler Health Declaration Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2020 6 Months From Approved
955,000 0 0
136,667 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 955,000 0 0 955,000 0 0
Annual Time Burden (Hours) 136,667 0 0 136,667 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No