Information Collection

Traveler-based Genomic Surveillance Questionnaire

IC 259028 under ICR 202308-0920-006 · OMB 0920-1406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1406 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Traveler-based Genomic Surveillance Questionnaire	Form
Information Collection Instrument Attachment 3 - Information Collection instrument.docx	Form
Attachment 4C - Potential additional questions.docx Potential Additional Questions	IC Document
Attachment 4C - TGS potential additional questions_RSVclean.docx Att 4C_TGS_Additional Questions	IC Document

IC Title:

Traveler-based Genomic Surveillance Questionnaire

Agency IC Tracking Number:

0920-1406-23HP

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	n/a	Information Collection Instrument	Attachment 3 - Information Collection instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 555,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	555,000	555,000
Annual IC Time Burden (Hours)	46,250	46,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Potential Additional Questions	Attachment 4C - Potential additional questions.docx	03/09/2023
Att 4C_TGS_Additional Questions	Attachment 4C - TGS potential additional questions_RSVclean.docx	08/11/2023

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