COVID-2019 Referral Slip

2019 Novel Coronavirus Airport Entry Questionnaires

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: 640,000	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	640,000	-6,155,000	6,795,000
Annual IC Time Burden (Hours)	53,333	-512,917	566,250
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.