Information Collection

Traveler-based Genomic Surveillance Questionnaire

IC 259028 under ICR 202302-0920-019 · OMB 0920-1406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1406 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Traveler-based Genomic Surveillance Questionnaire	Form
Information Collection Instrument Attachment 3 - Information Collection instrument.docx	Form
Information Collection Instrument Attachment 3 - Information Collection instrument.docx	Form
Attachment 4C - Potential additional questions.docx Potential Additional Questions	IC Document
Attachment 4C - Potential additional questions.docx Potential Additional Questions	IC Document

IC Title:

Traveler-based Genomic Surveillance Questionnaire

Agency IC Tracking Number:

0920-22ET

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	n/a	Information Collection Instrument	Attachment 3 - Information Collection instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 555,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	555,000	555,000
Annual IC Time Burden (Hours)	46,250	46,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Potential Additional Questions	Attachment 4C - Potential additional questions.docx	03/09/2023

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