Information Collection

Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries

IC 256312 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries	Form and Instruction
PUBLIC HEALTH ASSESSMENT FOR TRAVELERS FROM EBOLA OUTBRE Attachment D-Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries.docx	Form and Instruction

IC Title:

Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Form and Instruction	NA	PUBLIC HEALTH ASSESSMENT FOR TRAVELERS FROM EBOLA OUTBREAK-AFFECTED COUNTRIES	Attachment D-Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries.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: 5,365

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,365	5,365
Annual IC Time Burden (Hours)	1,788	1,788
Annual IC Cost Burden (Dollars)	0	0

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.