Cumulative Influenza/Influenza-Like Illness (ILI) Form

Foreign Quarantine Regulations (42CFR71)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0134 can be found here:

Documents and Forms

Document Name Document Type
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form Attachment E - Maritime Conveyance Cumulative Influenza or Influenza-Like Illness (ILI) Form.pdf Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form Attachment E - Maritime Conveyance Cumulative Influenza or Influenza-Like Illness (ILI) Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Cumulative Influenza/Influenza-Like Illness (ILI) Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 71

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Cumulative Influenza/Influenza-Like Illness (ILI) Form	Attachment E - Maritime Conveyance Cumulative Influenza or Influenza-Like Illness (ILI) Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine- and Traveler-Related Activities, Including Records for Tracing Contact Investigation	FR Citation: 72 FR 7086

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	3,893	3,893

Documents for IC

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.