[NCEZID] Traveler-based Genomic Surveillance Questionnaire (24BT)

[NCEZID] Traveler-based Genomic Surveillance

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 0920-1406 Traveler-based Genomic Surveillance Questionnaire Form
Form 0920-1406 [NCEZID] Traveler-based Genomic Surveillance Questionnaire (24BT) Form
Attachment 4C - TGS potential additional questions_symptoms_clean.docx Other-WORD
0920-1406 TGS Updated Digital Collection + Double Collection Quest Attachment 3 - Information Collection instrument.docx Form
0920-1406 TGS Updated Digital Collection + Double Collection Quest Attachment 3 - Information Collection instrument.docx Form
Attachment 4C - Potential additional questions.docx Potential Additional Questions IC Document
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
Attachment 4C - TGS potential additional questions_RSVclean.docx Att 4C_TGS_Additional Questions IC Document
Attachment 4C - TGS potential additional questions_symptoms_clean.docx Att 4C - TGS potential additional questions (final) 24BT IC Document
Attachment 4C - TGS potential additional questions_symptoms_tracked.docx Att 4C - TGS potential additional questions (Track changes) 24BT IC Document

Information Collection (IC) Details

IC Title:	[NCEZID] Traveler-based Genomic Surveillance Questionnaire (24BT)	Agency IC Tracking Number:

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	0920-1406	TGS Updated Digital Collection + Double Collection Questionnaire	Attachment 3 - Information Collection instrument.docx		Yes	Yes	Fillable Fileable
Other-WORD			Attachment 4C - TGS potential additional questions_symptoms_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: 555,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	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

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
Att 4C - TGS potential additional questions (Track changes) 24BT	Attachment 4C - TGS potential additional questions_symptoms_tracked.docx	01/05/2024

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