Information Collection

Enhanced Data Collection During COVID-19 Pandemic

IC 241195 under ICR 202004-0920-003 · OMB 0920-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Enhanced Data Collection During COVID-19 Pandemic	Form and Instruction
Enhanced Data Collection During COVID-19 Pandemic Attachment B Enhanced Data Collection During COVID-19.docx	Form and Instruction
Attachment A - Maritime Conveyance Cumulative Influenza LIke Illness form.pdf Attachment A referenced in the April 2020 change request adding the new COVID enhanced data collection form	IC Document

IC Title:

Enhanced Data Collection During COVID-19 Pandemic

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 71

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
Form and Instruction	n/a	Enhanced Data Collection During COVID-19 Pandemic	Attachment B Enhanced Data Collection During COVID-19.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Quarantine- and Traveler-Related Activities, Including Records for Tracing Contact Investigation

FR Citation: 72 FR 7086

Number of Respondents: 250

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,000	13,000
Annual IC Time Burden (Hours)	2,167	2,167
Annual IC Cost Burden (Dollars)	84,348	84,348

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A referenced in the April 2020 change request adding the new COVID enhanced data collection form	Attachment A - Maritime Conveyance Cumulative Influenza LIke Illness form.pdf	04/07/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.