State/Local TB Outcoming Reporting (Air)

Contact Investigation Outcome Reporting Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0900 can be found here:

Documents and Forms

Document Name Document Type
State/Local TB Outcoming Reporting (Air) Form
TB Contact Investigation Outcome Reporting Form - Air Attachment H -TB Outcome Reporting Form Air Travel.pdf Form
TB Contact Investigation Outcome Reporting Form - Air Attachment H -TB Outcome Reporting Form Air Travel.pdf Form

Information Collection (IC) Details

IC Title:	State/Local TB Outcoming Reporting (Air)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form	n/a	TB Contact Investigation Outcome Reporting Form - Air	Attachment H -TB Outcome Reporting Form Air Travel.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 0920-0171 Quarantine and Traveler Related Activities, Including Records for Cpmtact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 70867

Number of Respondents: 38	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	38	-509	547
Annual IC Time Burden (Hours)	3	-43	46
Annual IC Cost Burden (Dollars)	118	-1,583	1,701

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.