Foreign Quarantine Regulations (42CFR71)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 42CFR 71.21(a) Maritime Conveyance illness or Death Investigation Form	Form and Instruction	Unchanged	Available
Form 42CFR 71.21(a) Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)	Form and Instruction	Unchanged	Repair queued
Form 0920-0134 Air Travel Illness or Death Investigation Form	Form and Instruction	New	Available
Form 0920-0134 Air Travel Illness or Death Investigation Form	Form and Instruction	New	Repair queued
Land Travel Illness or Death Investigation Form	Form	Unchanged	Available
Land Travel Illness or Death Investigation Form	Form	Unchanged	Repair queued
Form 42 CFR 71.21(a) Maritime Conveyance Illness or Death Investigation Form (Section 5)	Form and Instruction	Unchanged	Available
Form 42 CFR 71.21(a) Maritime Conveyance Illness or Death Investigation Form (Section 5)	Form and Instruction	Unchanged	Repair queued
Cumulative Influenza/Influenza-Like Illness (ILI) Form	Form and Instruction	Unchanged	Available
Cumulative Influenza/Influenza-Like Illness (ILI) Form	Form and Instruction	Unchanged	Repair queued
0920-0134 Change Request-5.12.2023.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-05-12	Available
0920-0134 Change Request-5.12.2023.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-05-12	Repair queued
Attachment H - IRB Non-Research Determination.pdf	Supplementary Document	Uploaded 2022-03-30	Available
Attachment H - IRB Non-Research Determination.pdf	Supplementary Document	Uploaded 2022-03-30	Repair queued
Attachment G Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2022-03-30	Available
Attachment G Privacy Impact Assessment.pdf	Supplementary Document	Uploaded 2022-03-30	Repair queued
Attachment B - 60 Day FRN - 0920-0134.pdf	Supplementary Document	Uploaded 2022-03-30	Available
Attachment B - 60 Day FRN - 0920-0134.pdf	Supplementary Document	Uploaded 2022-03-30	Repair queued
0920-0134 Foreign Quarantine Reg SSA3.23.2022_final.docx	Supporting Statement A	Uploaded 2022-03-30	Available
0920-0134 Foreign Quarantine Reg SSA3.23.2022_final.docx	Supporting Statement A	Uploaded 2022-03-30	Repair queued
0920-0134 Foreign Quarantine Reg SSB3.23.2022.docx	Supporting Statement B	Uploaded 2022-03-30	Available
0920-0134 Foreign Quarantine Reg SSB3.23.2022.docx	Supporting Statement B	Uploaded 2022-03-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6646	Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)	Form and Instruction	Unchanged	Maritime Conveyance illness or Death Investigation Form
6646	Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)	Form and Instruction	Unchanged
260175	Air Travel Illness or Death Investigation Form	Form and Instruction	New	Air Travel Illness or Death Investigation Form
260175	Air Travel Illness or Death Investigation Form	Form and Instruction	New
234020	Land Travel Illness or Death Investigation Form	Form	Unchanged	Land Travel Illness or Death Investigation Form
234020	Land Travel Illness or Death Investigation Form	Form	Unchanged
234019	Maritime Conveyance Illness or Death Investigation Form (Section 5)	Form and Instruction	Unchanged	Maritime Conveyance Illness or Death Investigation Form (Section 5)
234019	Maritime Conveyance Illness or Death Investigation Form (Section 5)	Form and Instruction	Unchanged
234012	Cumulative Influenza/Influenza-Like Illness (ILI) Form	Form and Instruction	Unchanged	Cumulative Influenza/Influenza-Like Illness (ILI) Form
234012	Cumulative Influenza/Influenza-Like Illness (ILI) Form	Form and Instruction	Unchanged
202072	Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft		Modified
189693	42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form))		Unchanged
189692	42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form))		Unchanged

ICR Details

OMB Control No: 0920-0134	ICR Reference No: 202305-0920-006
Status: Historical Active	Previous ICR Reference No: 202203-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0134
Title: Foreign Quarantine Regulations (42CFR71)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/16/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/12/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	03/31/2026	03/31/2026
Responses	14,616	0	86,116
Time Burden (Hours)	2,078	0	3,595
Cost Burden (Dollars)	22,027	0	218,318

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Abstract: The goal of this information collection is to facilitate a CDC public health mission as provided under the Public Health Service Act and Code of Federal Regulations. This Non-Substantive Change Request adds the Air Travel Illness or Death Investigation Form that was previously approved under OMB Control No. 0920-1318 and results in an overall reduction in burden due to a reduction in the number of illness or deaths reported.

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Authorizing Statute(s): US Code: 42 USC 264 Name of Law: Public Health Service Act
   Statute at Large: 42 Stat. 70
   Statute at Large: 42 Stat. 71
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 977	01/07/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 18797	03/31/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form))
42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form))
Air Travel Illness or Death Investigation Form	0920-0134	Air Travel Illness or Death Investigation Form
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)	42CFR 71.21(a)	Maritime Conveyance illness or Death Investigation Form
Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft
Cumulative Influenza/Influenza-Like Illness (ILI) Form	none	Cumulative Influenza/Influenza-Like Illness (ILI) Form
Land Travel Illness or Death Investigation Form	none	Land Travel Illness or Death Investigation Form
Maritime Conveyance Illness or Death Investigation Form (Section 5)	42 CFR 71.21(a)	Maritime Conveyance Illness or Death Investigation Form (Section 5)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	14,616	86,116	0	-71,500	0	0
Annual Time Burden (Hours)	2,078	3,595	0	-1,517	0	0
Annual Cost Burden (Dollars)	22,027	218,318	0	-196,291	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Change Request is submitted to add the Air Travel Illness and Death Investigation Form back into 0920-0134, and an overall reduction in the number of illness or deaths reported.

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Annual Cost to Federal Government: $2,616,750

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/12/2023

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