Information Collection

Request dor Humanitarian Exception – (No form)

IC 257663 under ICR 202212-0920-017 · OMB 0920-1380.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Request dor Humanitarian Exception – (No form)	Form and Instruction
Information Needed to Process Humanitarian Testing Exception Request dor Humanitarian Exception – (No form)	Form and Instruction
Information Needed to Process Humanitarian Testing Excep Attachment D-Information Needed to Apply for Humanitarian Exception to Testing Requirement-PRC.pdf	Form and Instruction
Information Needed to Process Humanitarian Testing Excep Attachment D-Information Needed to Apply for Humanitarian Exception to Testing Requirement-PRC.pdf	Form and Instruction

IC Title:

Request dor Humanitarian Exception â (No form)

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			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-20-0171 - Quarantine- and Traveler-Related Activies

FR Citation: 72 FR 70867

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	40	40
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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