Foreign Quarantine Regulations (42CFR71)

OMB 0920-0134

The goal of this information collection is to facilitate a CDC public health mission as provided under the PHSA and Code of Federal Regulations. Collected information is intended to prevent the spread of communicable disease into and within the United States. CDC is requesting approval for a set of changes to the “Enhanced Data Collection During COVID-19 Pandemic” REDCap form to facilitate collection of the data from cruise ships under the extended No Sail Order of July 16, 2020 and an additional form.

The latest form for Foreign Quarantine Regulations (42CFR71) expires 2022-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 42CFR 71.21(a) Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction
Form 42CFR 71.21(a) Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction
Form 0920-0134 Air Travel Illness or Death Investigation Form Form and Instruction
Form 0920-0134 Air Travel Illness or Death Investigation Form Form and Instruction
Land Travel Illness or Death Investigation Form Form
Land Travel Illness or Death Investigation Form Form
Form 42 CFR 71.21(a) Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction
Form 42 CFR 71.21(a) Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction
0920-0134 Change Request-5.12.2023.docx Justification for No Material/Nonsubstantive Change
0920-0134 Change Request-5.12.2023.docx Justification for No Material/Nonsubstantive Change
Attachment H - IRB Non-Research Determination.pdf Supplementary Document
Attachment H - IRB Non-Research Determination.pdf Supplementary Document
Attachment G Privacy Impact Assessment.pdf Supplementary Document
Attachment G Privacy Impact Assessment.pdf Supplementary Document
Attachment B - 60 Day FRN - 0920-0134.pdf Supplementary Document
Attachment B - 60 Day FRN - 0920-0134.pdf Supplementary Document
0920-0134 Foreign Quarantine Reg SSA3.23.2022_final.docx Supporting Statement A
0920-0134 Foreign Quarantine Reg SSA3.23.2022_final.docx Supporting Statement A
0920-0134 Foreign Quarantine Reg SSB3.23.2022.docx Supporting Statement B
0920-0134 Foreign Quarantine Reg SSB3.23.2022.docx Supporting Statement B
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction
Air Travel Illness or Death Investigation Form Form and Instruction
Air Travel Illness or Death Investigation Form Form and Instruction
Land Travel Illness or Death Investigation Form Form
Land Travel Illness or Death Investigation Form Form
Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction
Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction
Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft
42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form))
42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form))

All Historical Document Collections

202305-0920-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-05-12
202203-0920-014 Approved without change	Revision of a currently approved collection	2022-03-31
202111-0920-018 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-11-18
202111-0920-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-11-03
202107-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-07-23
202009-0920-024 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-10-05
202007-0920-016 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-07-24
202004-0920-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-14
202004-0920-003 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-04-07
201904-0920-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-04-26
201811-0920-003 Approved with change	Revision of a currently approved collection	2018-11-27
201611-0920-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-11-16
201608-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-08-16
201509-0920-005 Approved with change	Revision of a currently approved collection	2015-11-17
201502-0920-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-02-18
201406-0920-014 Approved with change	Revision of a currently approved collection	2014-07-02
201305-0920-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2013-05-08
201304-0920-018 Approved with change	No material or nonsubstantive change to a currently approved collection	2013-04-29
201304-0920-012 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2013-04-19
201208-0920-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-08-02
201207-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-07-27
201204-0920-005 Approved with change	Revision of a currently approved collection	2012-04-25
201110-0920-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-10-04
200906-0920-019 Approved without change	Extension without change of a currently approved collection	2009-06-24
200509-0920-010 Approved with change	Revision of a currently approved collection	2005-09-23
200110-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2001-10-22
200107-0920-003 Approved without change	Extension without change of a currently approved collection	2001-07-23
199803-0920-003 Approved without change	Reinstatement with change of a previously approved collection	1998-03-26
199405-0920-002 Approved without change	Revision of a currently approved collection	1994-05-20
199105-0920-001 Approved without change	Reinstatement with change of a previously approved collection	1991-05-13
199102-0920-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-02-04
198903-0920-002 Approved without change	Extension without change of a currently approved collection	1989-03-09
198812-0920-001 Approved without change	Reinstatement with change of a previously approved collection	1988-12-07
198604-0920-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-04-07
198509-0920-002 Approved without change	Revision of a currently approved collection	1985-09-30
198501-0920-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1985-01-25
198308-0920-003 Approved without change	New collection (Request for a new OMB Control Number)	1983-08-10

OMB Details

Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)

Federal Enterprise Architecture: Health - Immunization Management

Form 42CFR 71.21(a)

Maritime Conveyance illness or Death Investigation Form

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.