Information Collection

POE Public Health Risk Assessment Form - CDC Marburg Response

IC 271517 under ICR 202410-0920-017 · OMB 0920-1443.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1443 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
POE Public Health Risk Assessment Form - CDC Marburg Response	Form and Instruction
CDC RISK ASSESSMENT AT POE (CDC Secondary) – Marburg Response POE Public Health Risk Assessment Form - CDC Marburg Response	Form and Instruction
Form 0920-1443 CDC RISK ASSESSMENT AT POE (CDC Secondary) – Marburg Response POE Public Health Risk Assessment Form - CDC Marburg Response	Form and Instruction
CDC RISK ASSESSMENT AT POE (CDC Secondary) – Marburg Res Attachment D - POE Public Health Risk Assessment Form_CDC Marburg Response_10 08 2024.docx	Form and Instruction
CDC RISK ASSESSMENT AT POE (CDC Secondary) – Marburg Res Attachment D - POE Public Health Risk Assessment Form_CDC Marburg Response_10 08 2024.docx	Form and Instruction
0920-1443 CDC RISK ASSESSMENT AT POE (CDC Secondary) – Marburg Res Attachment D- POE Public Health Risk Assessment Form_Marburg 16OCT2024.docx.docx	Form and Instruction
0920-1443 CDC RISK ASSESSMENT AT POE (CDC Secondary) – Marburg Res Attachment D- POE Public Health Risk Assessment Form_Marburg 16OCT2024.docx.docx	Form and Instruction

IC Title:

POE Public Health Risk Assessment Form - CDC Marburg Response

Agency IC Tracking Number:

0920-25AE

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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 and Instruction	n/a				Yes	Yes	Fillable Fileable
Form and Instruction	0920-1443			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Quarantine- and Traveler-Related Activities, including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71

FR Citation: 83 FR 6591

Number of Respondents: 4,380

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,380	4,380
Annual IC Time Burden (Hours)	1,460	1,460
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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