Information Collection

42 CFR 71.33 Report by Persons in Isolation or Surveillance

IC 279572 under ICR 202603-0920-009 · OMB 0920-0488.

Documents and Forms

Document Name Document Type
Form 0920-26-0140 42 CFR 71.33 Report by Persons in Isolation or Surveillance 42 CFR 71.33 Report by Persons in Isolation or Surveillance Form and Instruction
0920-26-0140 42 CFR 71.33 Report by Persons in Isolation or Surveilla Attachment 6 Master of Vessel or Conveyance Illness Report 101712 (1).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	42 CFR 71.33 Report by Persons in Isolation or Surveillance	Agency IC Tracking Number:	0920-26-0140

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-26-0140	42 CFR 71.33 Report by Persons in Isolation or Surveillance	Attachment 6 Master of Vessel or Conveyance Illness Report 101712 (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11	11
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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

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