Air Travel Illness or Death Investigation Form

Foreign Quarantine Regulations (42CFR71)

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.