Information Collection

Maritime Conveyance Illness or Death Investigation Form [Section 5]

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

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	n/a				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 %

table that charts list of burden
	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

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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