Information Collection Request

2019 Novel Coronavirus Airport Entry Questionnaires

ICR 202005-0920-013 · OMB 0920-1287 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-20HF Air Traveler Illness or Death Investigation Form Form and Instruction Modified Available
Form 0920-20HF US Traveler Health Declaration Repatriation from Ship Form and Instruction Unchanged Available
Form 0920-20HF Supplemental Questionnaire Form and Instruction Modified Available
Form 0920-20HF Referral Slip Form and Instruction Modified Available
Form 0920-20HF Preboarding Health Screen Form and Instruction Unchanged Available
Form 0920-20HF US Traveler Health Declaration for Repatriation Form and Instruction Unchanged Available
Form 0920-1287 US Traveler Health Declaration - Brazil - Paper Format Form and Instruction Modified Available
Form 0920-1287 U.S. Traveler Health Declaration England/Ireland Fillable PDF Form and Instruction Modified Available
Form 0920-1287 U.S. Traveler Health Declaration England/Ireland Paper Form and Instruction Modified Available
Form 0920-20HF US Traveler Health Declaration Paper Form and Instruction Modified Available
Form 0920-20HF US Traveler Health Declaration Fillable PDF Form and Instruction Modified Available
Form 0920-20HF US Traveler health Declaration Web Form and Instruction Modified Available
0920-1287 Change Request- Airport Entry Screening Questionnaire 26MAY2020-GMTF-DGMQ.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-05-26 Available
0920-1287 Change Request- Airport Entry Screening Questionnaire.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-03-16 Available
Attachment L Wuhan Airport Entry Risk Assessment IRB.pdf Supplementary Document Uploaded 2020-03-09 Available
Attachment A2 42 CFR part 71.docx Supplementary Document Uploaded 2020-03-09 Available
Attachment A1 42 USC 264.pdf Supplementary Document Uploaded 2020-03-09 Available
SSB Emergency Clearance COVID-2019 Entry Risk Assessmentl-3.5.2020-Final-CLEAN.docx Supporting Statement B Uploaded 2020-03-09 Available
SSA Emergency Clearance COVID-2019 Entry Risk Assessment_3.5.2020_Final-CLEAN.docx Supporting Statement A Uploaded 2020-03-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
240643 COVID-2019 Air Traveler Illness and Death Investigation Form Form and Instruction ModifiedAir Traveler Illness or Death Investigation Form
240642 United States Travel Health Declaration for Repatriation from Ship Form and Instruction UnchangedUS Traveler Health Declaration Repatriation from Ship
239872 Daily Sympton Check Other-Recorded Unchanged
239871 Supplemental 2019 Questionnaire Form and Instruction ModifiedSupplemental Questionnaire
239870 COVID-2019 Referral Slip Form and Instruction ModifiedReferral Slip
239869 Preboarding Health Screen Form and Instruction UnchangedPreboarding Health Screen
239868 United States Travel Health Declaration for Repatriation Form and Instruction UnchangedUS Traveler Health Declaration for Repatriation
239867 United States Traveler Health Declaration Form and Instruction ModifiedUS Traveler Health Declaration - Brazil - Paper Format
239867 United States Traveler Health Declaration Form and Instruction ModifiedU.S. Traveler Health Declaration England/Ireland Fillable PDF
239867 United States Traveler Health Declaration Form and Instruction ModifiedU.S. Traveler Health Declaration England/Ireland Paper
239867 United States Traveler Health Declaration Form and Instruction ModifiedUS Traveler Health Declaration Paper
239867 United States Traveler Health Declaration Form and Instruction ModifiedUS Traveler Health Declaration Fillable PDF
239867 United States Traveler Health Declaration Form and Instruction ModifiedUS Traveler health Declaration Web

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2020 09/30/2020 09/30/2020
1,607,253 0 14,195,850
244,702 0 2,349,475
0 0 0





Reginfo record details
8
table that charts list of burden
IC Title Form No. Form Name
COVID-2019 Air Traveler Illness and Death Investigation Form 0920-20HF
COVID-2019 Referral Slip 0920-20HF
Daily Sympton Check
Preboarding Health Screen 0920-20HF
Supplemental 2019 Questionnaire 0920-20HF
United States Travel Health Declaration for Repatriation 0920-20HF
United States Travel Health Declaration for Repatriation from Ship 0920-20HF
United States Traveler Health Declaration 0920-1287, 0920-20HF, 0920-20HF, 0920-20HF, 0920-1287, 0920-1287 ,   ,   ,   ,   ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,607,253 14,195,850 0 -12,588,597 0 0
Annual Time Burden (Hours) 244,702 2,349,475 0 -2,104,773 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No