Information Collection

EVD Initial Screening Questions

IC 256311 under ICR 202210-0920-009 · OMB 0920-1375.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EVD Initial Screening Questions	Form and Instruction
INITIAL EBOLA SCREENING SCRIPT 0920-1375 Change Request-2022 Ebola Airport Entry Questionnaires_10.14.2022_final.docx	Form and Instruction
INITIAL EBOLA SCREENING SCRIPT 0920-1375 Change Request-2022 Ebola Airport Entry Questionnaires_10.14.2022_final.docx	Form and Instruction
Attachment G - Screening Script and SOP_clean_for OMB_10.14.2022_final.docx Screening Script and SOP	IC Document
Attachment G - Screening Script and SOP_clean_for OMB_10.14.2022_final.docx Screening Script and SOP	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	INITIAL EBOLA SCREENING SCRIPT	0920-1375 Change Request-2022 Ebola Airport Entry Questionnaires_10.14.2022_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 %

table that charts list of burden
	Approved	Previously Approved
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

table that charts IC Documents
Title	Document	Date Uploaded
Screening Script and SOP	Attachment G - Screening Script and SOP_clean_for OMB_10.14.2022_final.docx	10/19/2022

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