Change Request for
“2019 Novel Coronavirus Airport Entry Questionnaires”
(OMB Control No. 0920-1287)
Expiration Date: 09/30/2020
Program Contact
Amber Stolp
Office of Policy and Regulatory Affairs
Division of Global Migration and Quarantine
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
1600 Clifton Road, N.E., MS C12
Atlanta, Georgia 30333
Phone: 770.488.7018
Email: [email protected]
Submission Date: March 16, 2020
Circumstances of Change Request for OMB 0920-1287
The Centers for Disease Control and Prevention (CDC), Division of Global Migration and Quarantine (DGMQ) requests a nonmaterial/non-substantive of the currently approved Information Collection Request: “2019 Novel Coronavirus Airport Entry Questionnaires”.
The Traveler Health Declaration form is an information collection tool used by CDC to facilitate public health follow-up of travelers who may have been exposed to or infected with a communicable disease. Currently, CDC has Office of Management and Budget, Office of Information and Regulatory Affairs approval for a web-based, fillable-PDF, and paper-based Traveler Health Declaration form.
In response to the outbreak of coronavirus disease 2019 (COVID-19), CDC has been tasked with conducting public health assessments at U.S. airports of travelers coming from areas experiencing an outbreak of a novel (new) coronavirus (named “COVID-2019”). The purpose is to detect ill individuals or individuals at risk of being ill with COVID-2019, which was first detected in Wuhan City, Hubei Province, China. Currently, CDC is conducting these assessments for travelers from Hubei Province, other parts of China, and Iran as the response has evolved, CDC has been tasked with expanding the assessment for travelers from other outbreak areas which include the United Kingdom, Ireland, Iran, the Schengen Area (Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland, and Monaco, and Vatican City),
As such, CDC is requesting the following changes to include additional countries, and to incorporate feedback on ways to better improve processes and incorporate the changing nature of the COVID-2019 response:
Update the United States Traveler Health Declaration Form to include the following:
Add Schengen Areas (Austria, Belgium, Czech Republic, Demark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland, and Vatican City), Ireland and the United Kingdom to the list of countries that will be screened on the bottom of the form.
Remove question about contact with known case (“In the past 14 days, have you had contact with a person known to be infected with the novel coronavirus (COVID-2019)?”)
Remove “Country of Residence”, “Citizenship”, and “Passport number”
With regard to the question “Today or in the past 24 hours, have you had any of the following symptoms?”:
Replace “Cough?” with “New or worsening persistent (frequent or continuing) cough?”
Replace “Difficulty breathing?” with “New or worsening difficulty breathing?”
Remove “Time Start” and “Time End” and whether a translator was needed (on bottom of form)
Operationally:
The paper version of the United States Traveler Health Declaration Form will now be shared with TSA so airlines can provide the form to passengers coming to the United States on direct flights.
Travelers coming from any Schengen countries, Ireland, or the United Kingdom will also be screened
Increase in Annualized Total Burden Hours:
The original burden calculated for this data collection consisted of 136,667 hours. As a result of the changes proposed in this change request, the new burden will consist of 2,319,475 hours. An updated burden table is included below.
Attachments
Attachment D - COVID-2019 Fillable PDF – U.S. Traveler Health Declaration
Attachment E1 – COVID-2019 Paper Format – U.S. Traveler Health Declaration_tracked changes
Attachment E2 – COVID-2019 Paper Format – U.S. Traveler Health Declaration_clean
Respondent |
Form |
Number of Respondents
|
Number of Responses per Respondent |
Average Burden per Response (in minutes) |
Total Burden Hours |
Traveler |
United States Travel Health Declaration (English or Mandarin Chinese) |
6,795,000 |
1 |
15/60 |
1,698,750 |
Traveler |
Supplemental COVID-19 Questionnaire |
203,850 |
1 |
10/60 |
33,975 |
Traveler |
COVID-19 Air Travel Illness and Death Investigation Form |
82,000 |
1 |
15/60 |
20,500 |
Traveler |
COVID-19 Referral Slip |
6,795,000 |
1 |
5/60 |
566250 |
Total |
|
|
|
|
2,319,475 |
Increased burden associated with the United States Travel Health Declaration (English or Mandarin Chinese)
Respondents: 6,495,000
Hours: 1,623,750
Increased burden associated with the 2019-nCoV Supplementary Questionnaire
Respondents: 178,850
Hours: 29,808
Increased burden associated with the 2019-nCoV Air Travel Illness and Death Investigation Form
Respondents:72,000
Hours: 18,000
Increased burden associated with the 2019-nCoV Referral Slip
Respondents: 6,495,000
Hours: 541,250
Total increase burden: 2,182,808
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | JReichard |
| File Modified | 0000-00-00 |
| File Created | 2021-01-14 |