Land Travel Illness or Death Investigation Form

Foreign Quarantine Regulations (42CFR71)

OMB: 0920-0134

IC ID: 234020

Information Collection (IC) Details

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Land Travel Illness or Death Investigation Form
 
No Unchanged
 
Voluntary
 
42 CFR 70 sec 4 42 CFR 71 sec 21

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Land Travel Illness or Death Investigation Form Attachment F - Land Travel Illness or Death Investigation Form-3.23.pdf Yes No Fillable Fileable

Health Public Health Monitoring

Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation  72 FR 7086

3,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,000 0 0 0 0 3,000
Annual IC Time Burden (Hours) 750 0 0 0 0 750
Annual IC Cost Burden (Dollars) 5,842 0 0 0 0 5,842

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