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

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-26-0140				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 %

table that charts list of burden
	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

table that charts IC Documents
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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