COVID-2019 Referral Slip

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⚠️ Notice: This information collection may be referencing outdated material.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 Referral Slip Form and Instruction
0920-20HF Referral Slip Attachment I COVID-2019 Referral Slip-2.10.2020_Final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	COVID-2019 Referral Slip	Agency IC Tracking Number:	0920-20HF

Is this a Common Form? No		IC Status: Modified

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	Referral Slip	Attachment I COVID-2019 Referral Slip-2.10.2020_Final.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,795,000	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	Previously Approved
Annual Number of Responses for this IC	6,795,000	6,495,000	300,000
Annual IC Time Burden (Hours)	566,250	541,250	25,000
Annual IC Cost Burden (Dollars)	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.