Information Collection

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

IC 259028 under ICR 202404-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1406 [NCEZID] Traveler-based Genomic Surveillance Questionnaire (24EQ)	Form
Form 0920-1406 [NCEZID] Traveler-based Genomic Surveillance Questionnaire (24EQ)	Form
Attachment 4C - TGS potential additional questions_symptoms_clean.docx	Other-WORD
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
0920-1406 TGS Updated Digital Collection + Double Collection Quest Attachment 3 - Information Collection instrument_clean_2024_April8.docx	Form and Instruction
0920-1406 TGS Updated Digital Collection + Double Collection Quest Attachment 3 - Information Collection instrument_clean_2024_April8.docx	Form and Instruction
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_tracked.docx Att 4C - TGS potential additional questions (Track changes) 24BT	IC Document
Attachment 4C - TGS potential additional questions_symptoms_tracked.docx Att 4C - TGS potential additional questions (Track changes) 24BT	IC Document
Attachment 3 - Information Collection instrument_tracked_2024_April8.docx TGS Updated Digital Collection + Double Collection Questionnaire (DRAFT)	IC Document
Attachment 3 - Information Collection instrument_tracked_2024_April8.docx TGS Updated Digital Collection + Double Collection Questionnaire (DRAFT)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

0920-1406-24EQ

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	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
Form and Instruction	0920-1406	TGS Updated Digital Collection + Double Collection Questionnaire_rev. 2024	Attachment 3 - Information Collection instrument_clean_2024_April8.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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
Att 4C - TGS potential additional questions (Track changes) 24BT	Attachment 4C - TGS potential additional questions_symptoms_tracked.docx	01/05/2024
TGS Updated Digital Collection + Double Collection Questionnaire (DRAFT)	Attachment 3 - Information Collection instrument_tracked_2024_April8.docx	04/10/2024

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