Information Collection

Statement or Documentation of Non-Infectiousness

IC 253394 under ICR 202406-0920-001 · OMB 0920-1383.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1383 can be found here:

Documents and Forms

Document Name Document Type
Statement or Documentation of Non-Infectiousness.docx Other-Header and Burden Statement
Statement or Documentation of Non-Infectiousness.docx Other-Header and Burden Statement

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Statement or Documentation of Non-Infectiousness	Agency IC Tracking Number:	0920-1383

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
Other-Header and Burden Statement			Statement or Documentation of Non-Infectiousness.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine-and-Traveler-Related Activities	FR Citation: 83 FR 6591

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5,000	4,609	391
Annual IC Time Burden (Hours)	1,250	1,152	98
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.