[NCEZID] Land Travel-related Public Health Activities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 42CFR 71.21(a) Maritime Conveyance illness or Death Investigation Form	Form and Instruction	Removed	Available
Tuberculosis Land Conveyance Contact Investigation Outcome Reporting Form	Form and Instruction	New	Available
General Land Conveyance Contact Investigation Outcome Reporting Form	Form and Instruction	New	Available
Public Health Land Passenger Locator Form	Form and Instruction	New	Available
Form 0920-0134 Air Travel Illness or Death Investigation Form	Form and Instruction	Removed	Available
Land Travel Illness or Death Investigation Form	Form and Instruction	Modified	Available
Form 0920-25CC Maritime Conveyance Illness or Death Investigation Form Section 5	Form	Removed	Available
Cumulative Influenza/Influenza-Like Illness (ILI) Form	Form and Instruction	Removed	Available
Attachment B2 - Land Travel-related Public Health Activities_0920-0134_Public Comments_3.18.26.docx	Public Comments	Uploaded 2026-03-05	Available
Attachment J - Non-research Determination-0920-0134.pdf	Supplementary Document	Uploaded 2026-03-13	Available
Attachment I - QARS-PHARS_PIA.pdf	Supplementary Document	Uploaded 2026-03-13	Available
Attachment B1- 60 Day Federal Register Notice 2026-00422.pdf	Supplementary Document	Uploaded 2026-03-13	Available
Attachment A3 42 CFR part 70.pdf	Supplementary Document	Uploaded 2026-03-13	Available
Attachment A2 42 CFR part 71.pdf	Supplementary Document	Uploaded 2026-03-13	Available
Attachment A1 Section 361 of the Public Health Service Act (42 USC 264).pdf	Supplementary Document	Uploaded 2026-03-13	Available
SSA 0920-0134_Land Travel-related Activities_3.10.26-Final_final.docx	Supporting Statement A	Uploaded 2026-03-19	Available
SSB_0920-0134_Land Travel-related Activites_3.10.26-Final.docx	Supporting Statement B	Uploaded 2026-03-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6646	Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)	Form and Instruction	Removed	Maritime Conveyance illness or Death Investigation Form
6646	Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)	Form and Instruction	Removed
279497	Report by the Master of a Vessel or Person in Charge of Conveyance of the Incidence of a Communicable Disease Occurring While in Interstate Travel	Other-OMB Header and Burden Statement	New
279496	TB Land Contact Investigation Outcome Reporting Form	Form and Instruction	New	Tuberculosis Land Conveyance Contact Investigation Outcome Reporting Form
279496	TB Land Contact Investigation Outcome Reporting Form	Form and Instruction	New
279495	General Land Contact Investigation Outcome Reporting Form	Form and Instruction	New	General Land Conveyance Contact Investigation Outcome Reporting Form
279495	General Land Contact Investigation Outcome Reporting Form	Form and Instruction	New
279494	Domestic Land Conveyance Manifest Order Template	Instruction	New
279493	International Land Conveyance Manifest Order Template	Instruction	New
279492	Land Passenger Locator Form	Form and Instruction	New	Public Health Land Passenger Locator Form
279492	Land Passenger Locator Form	Form and Instruction	New
260175	Air Travel Illness or Death Investigation Form	Form and Instruction	Removed	Air Travel Illness or Death Investigation Form
260175	Air Travel Illness or Death Investigation Form	Form and Instruction	Removed
234020	Land Travel Illness or Death Investigation Form	Form and Instruction	Modified	Land Travel Illness or Death Investigation Form
234020	Land Travel Illness or Death Investigation Form	Form and Instruction	Modified
234019	Maritime Conveyance Illness or Death Investigation Form (Section 5)	Form	Removed	Maritime Conveyance Illness or Death Investigation Form Section 5
234019	Maritime Conveyance Illness or Death Investigation Form (Section 5)	Form	Removed
234012	Cumulative Influenza/Influenza-Like Illness (ILI) Form	Form and Instruction	Removed	Cumulative Influenza/Influenza-Like Illness (ILI) Form
234012	Cumulative Influenza/Influenza-Like Illness (ILI) Form	Form and Instruction	Removed
202072	Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft		Removed
189693	42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form))		Removed
189692	42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form))		Removed

ICR Details

OMB Control No: 0920-0134	ICR Reference No: 202603-0920-008
Status: Received in OIRA	Previous ICR Reference No: 202412-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0139
Title: [NCEZID] Land Travel-related Public Health Activities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/19/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2026
Responses	590	14,616
Time Burden (Hours)	156	2,078
Cost Burden (Dollars)	0	21,910

---

Abstract: The goal of this information collection is to facilitate a CDC public health mission as provided under the Public Health Service Act and Code of Federal Regulations. This Revision consolidates land travel-related public health information collections under one OMB control number, thereby improving efficiency of CDC’s land travel-related activities PRA submission process. It modifies current forms and add/deletes other forms which results in a burden change.

---

Authorizing Statute(s): Statute at Large: 42 Stat. 70
   Statute at Large: 42 Stat. 71
   US Code: 42 USC 264 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 1320	01/13/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 12805	03/17/2026
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form))
42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form))
Air Travel Illness or Death Investigation Form	0920-0134	Air Travel Illness or Death Investigation Form
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)	42CFR 71.21(a)	Maritime Conveyance illness or Death Investigation Form
Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft
Cumulative Influenza/Influenza-Like Illness (ILI) Form	none	Cumulative Influenza/Influenza-Like Illness (ILI) Form
Domestic Land Conveyance Manifest Order Template
General Land Contact Investigation Outcome Reporting Form	n/a	General Land Conveyance Contact Investigation Outcome Reporting Form
International Land Conveyance Manifest Order Template
Land Passenger Locator Form	n/a	Public Health Land Passenger Locator Form
Land Travel Illness or Death Investigation Form	none	Land Travel Illness or Death Investigation Form
Maritime Conveyance Illness or Death Investigation Form (Section 5)	0920-25CC	Maritime Conveyance Illness or Death Investigation Form Section 5
Report by the Master of a Vessel or Person in Charge of Conveyance of the Incidence of a Communicable Disease Occurring While in Interstate Travel
TB Land Contact Investigation Outcome Reporting Form	n/a	Tuberculosis Land Conveyance Contact Investigation Outcome Reporting Form

---

ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	590	14,616	0	-14,026	0	0
Annual Time Burden (Hours)	156	2,078	0	-1,922	0	0
Annual Cost Burden (Dollars)	0	21,910	0	-21,910	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden change is due to adding and removing forms.

---

Annual Cost to Federal Government: $214,197

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/19/2026

---