Information Collection

Traveler - Exemptiion Request Form

IC 283164 under ICR 202608-0920-009 · OMB 0920-1474.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1474 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-XXXX EXEMPTION REQUEST (No Form) Traveler - Exemptiion Request Form	Form and Instruction
Form 0920-XXXX EXEMPTION REQUEST (No Form) Traveler - Exemptiion Request Form	Form and Instruction
0920-XXXX EXEMPTION REQUEST (No Form) EXEMPTION REQUEST Placeholder.docx	Form and Instruction
0920-XXXX EXEMPTION REQUEST (No Form) EXEMPTION REQUEST Placeholder.docx	Form and Instruction

IC Title:

Traveler - Exemptiion Request Form

Agency IC Tracking Number:

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	0920-XXXX			N/A	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title: 09-20-0171, Quarantine- and Traveler-Related Activities, Including Records for Contact Tracing Investigation and Notification

FR Citation: 83 FR 6591

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	200	200
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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