Information Collection

Enhanced Data Collection During COVID-19 Pandemic

IC 241195 under ICR 202007-0920-016 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0134 Enhanced Data Collection During COVID-19 Pandemic	Form and Instruction
Attachment A2 Enhanced Data Collection During COVID-19 (REDCap Screenshot).docx	Other-Screenshot
0920-0134 Enhanced Data Collection During COVID-19 Pandemic Attachment A1 Enhanced Data Collection During COVID-19 (REDCap changes CLEAN).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: Modified

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	0920-0134	Enhanced Data Collection During COVID-19 Pandemic	Attachment A1 Enhanced Data Collection During COVID-19 (REDCap changes CLEAN).docx		Yes	Yes	Fillable Printable
Other-Screenshot			Attachment A2 Enhanced Data Collection During COVID-19 (REDCap Screenshot).docx		Yes	Yes	Fillable Fileable

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: 50

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	Previously Approved
Annual Number of Responses for this IC	2,600	-10,400	13,000
Annual IC Time Burden (Hours)	520	-1,647	2,167
Annual IC Cost Burden (Dollars)	16,870	-67,478	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.