Information Collection

Public Health Passenger Locator Form: limited onboard exposure* (domestic flights)

IC 279575 under ICR 202603-0920-009 · OMB 0920-0488.

Documents and Forms

Document Name Document Type
Form 0920-26-0140 Passenger Locator Form - DOMESTIC Public Health Passenger Locator Form: limited onboard exposure* (domestic flights) Form and Instruction
0920-26-0140 Passenger Locator Form - DOMESTIC Attachment D-Passenger Locator Form-Air.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Health Passenger Locator Form: limited onboard exposure* (domestic flights)	Agency IC Tracking Number:	0920-26-0140

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 71 42 CFR 70

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	Passenger Locator Form - DOMESTIC	Attachment D-Passenger Locator Form-Air.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Public Health Passenger Locator Form: limited onboard exposure* (international flights)	FR Citation: 72 FR 238

Number of Respondents: 545	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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	545	545
Annual IC Time Burden (Hours)	45	45
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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