Information Collection

Rubella Contact Investigation Outcome Reporting Form – Air

IC 279580 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 Rubella Contact Investigation Outcome Reporting Form – Air Rubella Contact Investigation Outcome Reporting Form – Air	Form and Instruction
0920-26-0140 Rubella Contact Investigation Outcome Reporting Form – A Attachment I-Rubella Aircraft Contact Investigation Outcome Reporting Form.docx	Form and Instruction

IC Title:

Rubella Contact Investigation Outcome Reporting Form â Air

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: Quarantine and Travel Related Activities, Including Records for Contact Tracing

FR Citation: 72 FR 239

Number of Respondents: 1

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1	-71	72
Annual IC Time Burden (Hours)	1	-5	6
Annual IC Cost Burden (Dollars)	0	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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