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Passenger Locator Form - domestic flights
Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)
OMB: 0920-1181
IC ID: 224286
OMB.report
HHS/CDC
OMB 0920-1181
ICR 202003-0920-003
IC 224286
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1181 can be found here:
2024-03-21 - Revision of a currently approved collection
2020-05-13 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Passenger Locator Form - domestic flights
Form
Passenger Locator Form
Attachment 11 Public Health Passenger Locator Form.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Passenger Locator Form - domestic flights
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR PHSA 42 CFR Foreign Quarantine Reg part 70 42 CFR Foreign Quarantine Reg part 71 (To search for a specific CFR, visit the
Code of Federal Regulations.
)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
none
Passenger Locator Form
Attachment 11 Public Health Passenger Locator Form.pdf
Yes
No
Paper Only
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 Investigation and Notification
FR Citation:
72 FR 239
Number of Respondents:
800
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
800
0
0
0
0
800
Annual IC Time Burden (Hours)
67
0
0
0
0
67
Annual IC Cost Burden (Dollars)
0
0
0
0
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.