Information Collection

EVD Initial Screening Questions

IC 256311 under ICR 202210-0920-002 · OMB 0920-1375.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1375 can be found here:

Documents and Forms

Document Name Document Type
EVD Initial Screening Questions Form and Instruction
INITIAL EBOLA SCREENING SCRIPT Attachment C-Ebola Initial Screening Questions_FINAL.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EVD Initial Screening Questions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	INITIAL EBOLA SCREENING SCRIPT	Attachment C-Ebola Initial Screening Questions_FINAL.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0171 - Quarantine- and Traveler-Related Activities	FR Citation: 83 FR 6591

Number of Respondents: 53,655	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53,655	53,655
Annual IC Time Burden (Hours)	4,471	4,471
Annual IC Cost Burden (Dollars)	0	0

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.