Information Collection

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

IC 246878 under ICR 202306-0920-002 · OMB 0920-1335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1335 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.