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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 259028 under ICR 202508-0920-004 · OMB unassigned.

Documents and Forms
Document Name
Document Type
Form
Form
Form and Instruction
Other-WORD
Form
Form
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

[NCEZID] Traveler-based Genomic Surveillance Questionnaire (24EQ)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1406 TGS Updated Digital Collection + Double Collection Questionnaire TGS questionnaire January 2025.docx Yes Yes Fillable Fileable
Other-WORD Attachment 4C - TGS potential additional questions_symptoms_clean.docx Yes Yes Fillable Fileable
Form 0920-1406 TGS Updated Digital Collection + Double Collection Questionnaire - Revised 22JUL2025 TGS_Questionnaire_Attachment3_20250709_clean.docx N/A Yes Yes Fillable Fileable
Form and Instruction 0920-1406 TGS Updated Digital Collection + Double Collection Questionnaire - Revised 14AUG2025 TGS_Questionnaire_20250811_clean.docx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

 

555,000 0
   
Individuals or Households
 
   90 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 555,000 0 0 0 0 555,000
Annual IC Time Burden (Hours) 37,000 0 0 0 0 37,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 4C - TGS potential additional questions (Track changes) 24BT Attachment 4C - TGS potential additional questions_symptoms_tracked.docx 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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