Information Collection

Cruise Ship Physician - COVID-19 Contact Investigation Worksheet (if necessary)

IC 248858 under ICR 202110-0920-007 · OMB 0920-1335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1335 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1335 Cruise Ship Physician - COVID-19 Contact Investigation Worksheet (if necessary)	Form
0920-1335 Cruise COVID-19 Contact Investigation Worksheet Contact Investigation Worksheet_08062021.xlsx	Form
0920-1335 Cruise COVID-19 Contact Investigation Worksheet Attachment N_Cruise COVID-19 Contact Investigation Worksheet.xlsx	Form

IC Title:

Cruise Ship Physician - COVID-19 Contact Investigation Worksheet (if necessary)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	0920-1335	Cruise COVID-19 Contact Investigation Worksheet	Contact Investigation Worksheet_08062021.xlsx	NA	Yes	Yes	Fillable Fileable
Form	0920-1335	Cruise COVID-19 Contact Investigation Worksheet	Attachment N_Cruise COVID-19 Contact Investigation Worksheet.xlsx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

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	24	-126	150
Annual IC Time Burden (Hours)	12	-63	75
Annual IC Cost Burden (Dollars)	0	0	0

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.