Information Collection Request

[NCZEID] Traveler Risk Assessment and Management Activities During Disease Outbreaks

ICR 202512-0920-006 · OMB unassigned · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-25-0004 Attachment H - CDC SAMPLE VHF Jurisdiction Final Survey Form and Instruction New Available
Form 0920-25-0004 CDC SAMPLE VHF Jurisdiction Final Survey Form and Instruction New Repair queued
Form 0920-25-0004 Attachment G - CDC SAMPLE VHF Jurisdiction Traveler Monitoring Form and Instruction New Repair queued
Form 0920-25-0004 CDC SAMPLE VHF Jurisdiction Traveler Monitoring Form and Instruction New Repair queued
Form 0920-25-0004 Attachment F - SAMPLE VHF Response Survey of Travelers Form and Instruction New Available
Form 0920-25-0004 SAMPLE VHF Response Survey of Travelers Form and Instruction New Repair queued
Form 0920-25-0004 Attachment E3 - SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction New Available
Form 0920-25-0004 SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction New Repair queued
Form 0920-25-0004 Attachment E2 - SAMPLE VHF Symptom Monitoring Weekly Group Form and Instruction New Available
Form 0920-25-0004 Sample VHF Symptom Monitoring Weekly Group Form and Instruction New Repair queued
Form 0920-25-0004 Attachment E3 - SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction New Repair queued
Form 0920-25-0004 SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction New Repair queued
Form 0920-25-0004 Attachment E1 - SAMPLE VHF Symptom Monitoring Daily Group Form New Available
Form 0920-25-0004 SAMPLE VHF Symptom Monitoring Daily Group Symptomatic Travelers Form New Repair queued
Form 0920-25-0004 Attachment D - POE Public Health Risk Assessment Form_SAMPLE VHF Form New Available
Form 0920-25-0004 POE Public Health Risk Assessment Form Form New Repair queued
Form 0920-25-0004 Attachment C - CDC Initial Screening Form_SAMPLE VHF Form New Repair queued
Form 0920-25-0004 Inital Screening Form Form New Repair queued
FRN Publication Request Worksheet.pdf Supplementary Document Uploaded 2025-12-10 Available
FRN Publication Request Worksheet.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
Attachment K - Non research determination.pdf Supplementary Document Uploaded 2025-12-10 Available
Attachment K - Non research determination.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
Attachment J - QARS SORN 09-20-0171.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
Attachment J - QARS SORN 09-20-0171.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
Attachment I -PHARS PIA.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
Attachment I -PHARS PIA.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
Attachment A2-42 CFR part 71.pdf Supplementary Document Uploaded 2025-12-10 Available
Attachment A2-42 CFR part 71.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
Attachment A1-42 USC 264.pdf Supplementary Document Uploaded 2025-12-10 Available
Attachment A1-42 USC 264.pdf Supplementary Document Uploaded 2025-12-10 Repair queued
SSB - 0920-XXXX_ 30-day_Traveler Risk Assessment & Management Gen-ICR.docx Supporting Statement B Uploaded 2025-12-10 Available
SSB - 0920-XXXX_ 30-day_Traveler Risk Assessment & Management Gen-ICR.docx Supporting Statement B Uploaded 2025-12-10 Repair queued
SSA - 0920-XXXX_ 30-day_Traveler Risk Assessment & Management Gen-ICR_09.16.25.docx Supporting Statement A Uploaded 2025-12-10 Repair queued
SSA - 0920-XXXX_ 30-day_Traveler Risk Assessment & Management Gen-ICR_09.16.25.docx Supporting Statement A Uploaded 2025-12-10 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
278403 CDC SAMPLE VHF Jurisdiction Final Survey Form and Instruction NewAttachment H - CDC SAMPLE VHF Jurisdiction Final Survey
278403 CDC SAMPLE VHF Jurisdiction Final Survey Form and Instruction New
278402 CDC SAMPLE VHF Jurisdiction Traveler Monitoring Form and Instruction NewAttachment G - CDC SAMPLE VHF Jurisdiction Traveler Monitoring
278402 CDC SAMPLE VHF Jurisdiction Traveler Monitoring Form and Instruction New
278401 SAMPLE VHF Response Survey of Travelers Form and Instruction NewAttachment F - SAMPLE VHF Response Survey of Travelers
278401 SAMPLE VHF Response Survey of Travelers Form and Instruction New
278400 SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction NewAttachment E3 - SAMPLE VHF Symptom Monitoring Web Survey
278400 SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction New
278399 Sample VHF Symptom Monitoring Weekly Group Form and Instruction NewAttachment E2 - SAMPLE VHF Symptom Monitoring Weekly Group
278399 Sample VHF Symptom Monitoring Weekly Group Form and Instruction New
278398 SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction NewAttachment E3 - SAMPLE VHF Symptom Monitoring Web Survey
278398 SAMPLE VHF Symptom Monitoring Web Survey Form and Instruction New
278397 SAMPLE VHF Symptom Monitoring Daily Group Symptomatic Travelers Form NewAttachment E1 - SAMPLE VHF Symptom Monitoring Daily Group
278397 SAMPLE VHF Symptom Monitoring Daily Group Symptomatic Travelers Form New
278396 POE Public Health Risk Assessment Form Form NewAttachment D - POE Public Health Risk Assessment Form_SAMPLE VHF
278396 POE Public Health Risk Assessment Form Form New
278395 Inital Screening Form Form NewAttachment C - CDC Initial Screening Form_SAMPLE VHF
278395 Inital Screening Form Form New

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
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table that charts list of burden
IC Title Form No. Form Name
CDC SAMPLE VHF Jurisdiction Final Survey 0920-25-0004
CDC SAMPLE VHF Jurisdiction Traveler Monitoring 0920-25-0004
Inital Screening Form 0920-25-0004
POE Public Health Risk Assessment Form 0920-25-0004
SAMPLE VHF Response Survey of Travelers 0920-25-0004
SAMPLE VHF Symptom Monitoring Daily Group Symptomatic Travelers 0920-25-0004
SAMPLE VHF Symptom Monitoring Web Survey 0920-25-0004
SAMPLE VHF Symptom Monitoring Web Survey 0920-25-0004
Sample VHF Symptom Monitoring Weekly Group 0920-25-0004



Reginfo record details
  No