Information Collection

Maritime Conveyance Illness or Death Investigation Form [Section 5]

IC 279763 under ICR 202603-0920-015 · OMB 0920-1335.

Documents and Forms

Document Name Document Type
Maritime Conveyance Illness or Death Investigation Form Maritime Conveyance Illness or Death Investigation Form [Section 5] Form and Instruction
Maritime Conveyance Illness or Death Investigation Form Attachment C - Maritime-Conveyance-Illness-or-Death-Investigation-Form.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Maritime Conveyance Illness or Death Investigation Form [Section 5]	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
Form and Instruction	n/a	Maritime Conveyance Illness or Death Investigation Form	Attachment C - Maritime-Conveyance-Illness-or-Death-Investigation-Form.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: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].