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Maritime Conveyance Illness or Death Investigation Form (Section 5)

IC 234019 under ICR 202603-0920-008 · OMB 0920-0134.

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Maritime Conveyance Illness or Death Investigation Form (Section 5) 0920-25CC
 
No Removed
 
Mandatory
 
42 CFR 71

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-25CC Maritime Conveyance Illness or Death Investigation Form Section 5 Attachment D - 0920-0134_Maritime Conveyance Illness or Death Investigation Form_Clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation  72 FR 7086

100 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Requested 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 0 0 -100 0 0 100
Annual IC Time Burden (Hours) 0 0 -8 0 0 8
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Change Request Memo 0920-0134 Change Request-Maritime Conveyance Illness or Death Investigation Form_12.12.2024.docx 12/17/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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