Information Collection

Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries

IC 256312 under ICR 202210-0920-009 · OMB 0920-1375.

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 OUTBREAK-AFFECTED COUNTRIES 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
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:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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			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	Previously Approved
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.

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