Information Collection

Cruise Ship Physician - COVID-19 Case Investigation Worksheet (if necessary)

IC 248855 under ICR 202303-0920-003 · OMB 0920-1335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1335 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1335 Cruise Ship Physician - COVID-19 Case Investigation Worksheet (if necessary) Form
0920-1335 COVID-19 Case Investigation worksheet Case Investigation Worksheet_08062021.xlsx Form
0920-1335 COVID-19 Case Investigation worksheet Case Investigation Worksheet_08062021.xlsx Form
0920-1335 Attachment K_Cruise COVID19 Case Investigation Worksheet Attachment K_Cruise COVID19 Case Investigation Worksheet.xlsx Form
0920-1335 Attachment K_Cruise COVID19 Case Investigation Worksheet Attachment K_Cruise COVID19 Case Investigation Worksheet.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Cruise Ship Physician - COVID-19 Case Investigation Worksheet (if necessary)	Agency IC Tracking Number:	0920-1335

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-1335	COVID-19 Case Investigation worksheet	Case Investigation Worksheet_08062021.xlsx	NA	Yes	Yes	Fillable Fileable
Form	0920-1335	Attachment K_Cruise COVID19 Case Investigation Worksheet	Attachment K_Cruise COVID19 Case Investigation Worksheet.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 104	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	104	104
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.