Information Collection

COVID-19 Conditional Sailing Certificate Application

IC 245868 under ICR 202102-0920-009 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
COVID-19 Conditional Sailing Certificate Application	Form
COVID-19 Conditional Sailing Certificate Application Attachment M. CDC COVID-19 Conditional Sailing Certificate Application.docx	Form
COVID-19 Conditional Sailing Certificate Application Attachment M. CDC COVID-19 Conditional Sailing Certificate Application.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	none	COVID-19 Conditional Sailing Certificate Application	Attachment M. CDC COVID-19 Conditional Sailing Certificate Application.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 130

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	130	130
Annual IC Time Burden (Hours)	1,300	1,300
Annual IC Cost Burden (Dollars)	109,213	109,213

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.