State/Local General Contact Reporting (Land)

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0900 State/Local General Contact Reporting (Land) Form
0920-0900 General Contact Investigation Outcome Reporting Form (La Attachment K - General Contact Investigation Outcome Reporting Form - final.docx Form
0920-0900 General Contact Investigation Outcome Reporting Form (La Attachment K - General Contact Investigation Outcome Reporting Form - final.docx Form
Attachment K - General Contact Investigation Outcome Reporting Form - redline.docx General Air Contact Investigation Outcome Reporting Form IC Document
Attachment K - General Contact Investigation Outcome Reporting Form - redline.docx General Air Contact Investigation Outcome Reporting Form IC Document

Information Collection (IC) Details

IC Title:	State/Local General Contact Reporting (Land)	Agency IC Tracking Number:	0920-0900-22AK

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	0920-0900	General Contact Investigation Outcome Reporting Form (Land)	Attachment K - General Contact Investigation Outcome Reporting Form - final.docx		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: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	47	47

Documents for IC

Title	Document	Date Uploaded
General Air Contact Investigation Outcome Reporting Form	Attachment K - General Contact Investigation Outcome Reporting Form - redline.docx	11/01/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.