Information Collection

Air Travel Illness or Death Investigation Form

IC 260175 under ICR 202305-0920-006 · OMB 0920-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0134 Air Travel Illness or Death Investigation Form	Form and Instruction
Form 0920-0134 Air Travel Illness or Death Investigation Form	Form and Instruction
0920-0134 Air Travel Illness or Death Investigation Form Attachment A -Air Travel Illness or Death Investigation-3.8.2023.docx	Form and Instruction
0920-0134 Air Travel Illness or Death Investigation Form Attachment A -Air Travel Illness or Death Investigation-3.8.2023.docx	Form and Instruction

IC Title:

Air Travel Illness or Death Investigation Form

Agency IC Tracking Number:

0920-0134

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	0920-0134	Air Travel Illness or Death Investigation Form	Attachment A -Air Travel Illness or Death Investigation-3.8.2023.docx	NA	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing I

FR Citation: 72 FR 7086

Number of Respondents: 4,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,000	1,000
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.