AGE Illness Report 4 hours before arrival (phone/email/fax)

Maritime Illness Database and Reporting System (MIDRS)

OMB: 0920-1260

IC ID: 252596

Information Collection (IC) Details

View Information Collection (IC)

AGE Illness Report 4 hours before arrival (phone/email/fax) 0920-1260
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1260 Att5a2 4 hr AGEIllnssRprt (phone email fax) 20220125 Att5a2 24-4-hr AGEIllnssRprt (phone email fax) 20220125.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

134 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 4,020 0 4,020 0 0 0
Annual IC Time Burden (Hours) 201 0 201 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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