Information Collection

Domestic non-TB Manifest Template and Informal Manifest Request

IC 224253 under ICR 202003-0920-003 · OMB 0920-1181.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1181 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 9 Informal manifest request template.doc	Instruction
Attachment 6 Domestic Non-TB Manifest Template Order.doc	Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Domestic non-TB Manifest Template and Informal Manifest Request

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 42 CFR Foreign Quarantine Reg part 71 42 CFR Foreign Quarantine Reg part 70 42 CFR Public Health Service Act (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 9 Informal manifest request template.doc		Yes	Yes	Fillable Fileable
Instruction			Attachment 6 Domestic Non-TB Manifest Template Order.doc		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Quarantine and Traveler Related Activities Including Records for Contact Tracing Investiagation and Notification

FR Citation: 72 FR 239

Number of Respondents: 28

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	168	168
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.