Information Collection

Public Health Passenger Locator Form_DOMESTIC

IC 241341 under ICR 202403-0920-010 · OMB 0920-1181.

Documents and Forms

Document Name Document Type
Form 0920-1181 Public Health Passenger Locator Form_DOMESTIC Form and Instruction
0920-1181 Public Health Passenger Locator Form_DOMESTIC Attachment 7_Public Health Passenger Locator Form.pdf Form and Instruction
0920-1181 Public Health Passenger Locator Form_DOMESTIC Attachment 7_Public Health Passenger Locator Form_revised.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Health Passenger Locator Form_DOMESTIC	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	0920-1181	Public Health Passenger Locator Form_DOMESTIC	Attachment 7_Public Health Passenger Locator Form_revised.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 545	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	545	-255	800
Annual IC Time Burden (Hours)	45	-22	67
Annual IC Cost Burden (Dollars)	0	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.