State/Local General Outcome Reporting (Air)

Contact Investigation Outcome Reporting Forms

OMB: 0920-0900

IC ID: 197945

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

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State/Local General Outcome Reporting (Air) 0920-0900-22AK
 
No Modified
 
Voluntary
 

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 - Air General Contact Investigation Outcome Reporting Form_Air_rev10.2021.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

0920-0171 Quarantine and Traveler Related Activities, Including Records for Cpmtact Tracing Investigation and Notification under 42 CFR Parts 70 and 71  72 FR 70867

16,672 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 16,672 0 0 0 0 16,672
Annual IC Time Burden (Hours) 1,389 0 0 0 0 1,389
Annual IC Cost Burden (Dollars) 51,850 0 0 0 0 51,850

Title Document Date Uploaded
General Air Contact Investigation Outcome Reporting Form General Contact Investigation Outcome Reporting Form_Air_redline.docx 11/01/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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