Maritime Conveyance Illness or Death Investigation Form (Section 5)

Foreign Quarantine Regulations (42CFR71)

OMB: 0920-0134

IC ID: 234019

Information Collection (IC) Details

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Maritime Conveyance Illness or Death Investigation Form (Section 5)
 
No Unchanged
 
Mandatory
 
42 CFR 71

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 42 CFR 71.21(a) Maritime Conveyance Illness or Death Investigation Form (Section 5) Attachment D Maritime Conveyance Illness or Death Investigation Form.pdf Yes No Fillable Fileable

Health Public Health Monitoring

Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation  72 FR 7086

100 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 100 0 0 0 0 100
Annual IC Time Burden (Hours) 3 0 0 0 0 3
Annual IC Cost Burden (Dollars) 117 0 0 0 0 117

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