Information Collection

Air Traveler (for illness or deathinvestigation) Air Travel Illness or Death Investigation or Traveler Follow-up Form

IC 250047 under ICR 202212-0920-016 · OMB 0920-1318.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1318 Air Traveler (for illness or deathinvestigation) Air Travel Illness or Death Investigation or Traveler Follow-up Form	Form and Instruction
0920-1318 Air Travel Illness or Death Investigation or Traveler Fo Attachment E-Air Travel Illness or Death Investigation or Traveler Follow up Form.pdf	Form and Instruction
0920-1318 Air Travel Illness or Death Investigation or Traveler Fo Attachment E-Air Travel Illness or Death Investigation or Traveler Follow up Form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-1318

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	0920-1318	Air Travel Illness or Death Investigation or Traveler Follow-up Form	Attachment E-Air Travel Illness or Death Investigation or Traveler Follow up Form.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0171 Quarantine- and Traveler-related Activities

FR Citation: 83 FR 6591

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,000	-55,000	65,000
Annual IC Time Burden (Hours)	2,500	-13,750	16,250
Annual IC Cost Burden (Dollars)	0	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.