Information Collection

Public Health Passenger Locator Form: outbreak of public health significance* (international flights)

IC 241342 under ICR 202004-0920-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1181 Public Health Passenger Locator Form: outbreak of public health significance* (international flights)	Form and Instruction
0920-1181 Public Health Passenger Locator Form: outbreak of public Attachment 12 Public Health Passenger Locator Form.pdf	Form and Instruction

IC Title:

Public Health Passenger Locator Form: outbreak of public health significance* (international flights)

Agency IC Tracking Number:

0920-1181

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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	0920-1181	Public Health Passenger Locator Form: outbreak of public health significance* (international flights)	Attachment 12 Public Health Passenger Locator Form.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,700,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,700,000	2,700,000
Annual IC Time Burden (Hours)	225,000	225,000
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.