Information Collection

Cruise Ship Brand/Operator - Agreement with Health Care Organization with signoff from Local Health Authorities

IC 246883 under ICR 202203-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Attachment N_Agreement with Health Care Organization Cruise Ship Brand/Operator - Agreement with Health Care Organization with signoff from Local Health Authorities	Form
ROCIS - Agreement with HCO and LHA.docx	Instruction
ROCIS - Agreement with HCO and LHA.docx	Instruction
0920-1335 Attachment N_Agreement with Health Care Organization Attachment N_Agreement with Health Care Organization.docx	Form
0920-1335 Attachment N_Agreement with Health Care Organization Attachment N_Agreement with Health Care Organization.docx	Form

IC Title:

Cruise Ship Brand/Operator - Agreement with Health Care Organization with signoff from Local Health Authorities

Agency IC Tracking Number:

0920-1335

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
Instruction			ROCIS - Agreement with HCO and LHA.docx		Yes	Yes	Fillable Fileable
Form	0920-1335	Attachment N_Agreement with Health Care Organization	Attachment N_Agreement with Health Care Organization.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	30	-30	60
Annual IC Time Burden (Hours)	300	-300	600
Annual IC Cost Burden (Dollars)	25,203	-25,203	50,406

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.