Information Collection

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

IC 259028 under ICR 202507-0920-016 · 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⚠️ Notice: This information collection may be referencing outdated material.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 TGS Updated Digital Collection + Double Collection Questionnaire [NCEZID] Traveler-based Genomic Surveillance Questionnaire (24EQ)	Form
Form 0920-1406 TGS Updated Digital Collection + Double Collection Questionnaire - Revised 22JUL2025 [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 TGS questionnaire January 2025.docx	Form
0920-1406 TGS Updated Digital Collection + Double Collection Quest TGS questionnaire January 2025.docx	Form
0920-1406 TGS Updated Digital Collection + Double Collection Quest TGS_Questionnaire_Attachment3_20250709_clean.docx	Form
0920-1406 TGS Updated Digital Collection + Double Collection Quest TGS_Questionnaire_Attachment3_20250709_clean.docx	Form
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

IC Title:

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

Agency IC Tracking Number:

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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-1406		Yes	Yes	Fillable Fileable
Other-WORD			Yes	Yes	Fillable Fileable
Form	0920-1406	N/A	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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	555,000	0	555,000
Annual IC Time Burden (Hours)	37,000	-9,250	46,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4C - TGS potential additional questions (Track changes) 24BT		01/05/2024

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

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