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Daily Sympton Check
2019 Novel Coronavirus Airport Entry Questionnaires
OMB: 0920-1287
IC ID: 239872
OMB.report
HHS/CDC
OMB 0920-1287
ICR 202005-0920-013
IC 239872
( )
Documents and Forms
Document Name
Document Type
Daily Symptom Check.docx
Other-Recorded
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Daily Sympton Check
Agency IC Tracking Number:
0920-20HF
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Recorded
Daily Symptom Check.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
280,000
0
0
0
0
280,000
Annual IC Time Burden (Hours)
23,333
0
0
0
0
23,333
Annual IC Cost Burden (Dollars)
0
0
0
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.
