Cruise Ship Physician - Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form

[NCEZID] Phased Approach to the Resumption of Cruise Ship Passenger Operations

⚠️ Notice: This information collection may be referencing outdated material.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
Cruise Ship Physician - Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form Form
Cruise Ship Cumulative Acute Respiratory Illness (ARI) R Attachment H_ARI reporting_6.2.2023-clean.docx Form
Attachment H_ARI reporting_6.2.2023-tracked.docx June 2023 edits (in tracked changes) to the Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form IC Document

Information Collection (IC) Details

IC Title:	Cruise Ship Physician - Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form	Agency IC Tracking Number:	0920-1335

Is this a Common Form? No		IC Status: Modified

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	None	Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form	Attachment H_ARI reporting_6.2.2023-clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,000	-41,450	47,450
Annual IC Time Burden (Hours)	1,000	-14,817	15,817
Annual IC Cost Burden (Dollars)	126,000	-870,450	996,450

Documents for IC

Title	Document	Date Uploaded
June 2023 edits (in tracked changes) to the Cruise Ship Cumulative Acute Respiratory Illness (ARI) Reporting Form	Attachment H_ARI reporting_6.2.2023-tracked.docx	06/06/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.