Information Collection

Report of Death Illness from Ship (Verbal-No Form)

IC 279760 under ICR 202603-0920-015 · OMB 0920-1335.

Documents and Forms

Document Name Document Type
OMB Control Header and Burden Statement.docx Other-OMB Header and Burden Statemen

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Death Illness from Ship (Verbal-No Form)	Agency IC Tracking Number:	0920-26-0163

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
Other-OMB Header and Burden Statement			OMB Control Header and Burden Statement.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Quarantine and Travel Related Activities, Including Records for Contact Tracing	FR Citation: 72 FR 239

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	6	6
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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