COVID-2019 Air Traveler Illness and Death Investigation Form

2019 Novel Coronavirus Airport Entry Questionnaires

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1287 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-20HF COVID-2019 Air Traveler Illness and Death Investigation Form Form and Instruction
0920-20HF Air Traveler Illness or Death Investigation Form Attachment K COVID-2019 Air Travel Illness or Death Investigation Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	COVID-2019 Air Traveler Illness and Death Investigation Form	Agency IC Tracking Number:	0920-20HF

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20HF	Air Traveler Illness or Death Investigation Form	Attachment K COVID-2019 Air Travel Illness or Death Investigation Form.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	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	10,000	10,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	0	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.