Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing

OMB 0920-0821

Latest Forms, Documents, and Supporting Material

Document Name
Ebola Entry Screening Risk Assessment (Ill Traveler Interview) Form and Instruction
Ebola Entry Screening Risk Assessment - ARABIC Form and Instruction
Ebola Entry Screening Risk Assessment - FRENCH Form and Instruction
Ebola Entry Screening Risk Assessment - ENGLISH Form and Instruction
United States Traveler Health Declaration - ARABIC Form and Instruction
United States Traveler Health Declaration - FRENCH Form and Instruction
United States Traveler Health Declaration - ENGLISH Form and Instruction
Air Travel Illness or Death Investigation Form
Land Travel Illness or Death Investigation Form
International Maritime Conveyance Illness or Death Investigation Form Form and Instruction
0920-0821 Revision Part B 02182016.docx Supporting Statement B
0920-0821 Revision Part A 02182016.doc Supporting Statement A
Attachment G Non-research Determination.pdf Supplementary Document
Attachment B 60 Day FRN 0920-0821.pdf Supplementary Document
Attachment A3 CFR-2013-title42-vol1-part71.pdf Supplementary Document
Attachment A2 CFR-2013-title42-vol1-part70.pdf Supplementary Document
Attachment A1 USCODE-2009-title42-chap6A-subchapII-partG.PDF Supplementary Document
Ebola Entry Screening Risk Assessment (Ill Traveler Interview) Form and Instruction
IVR Active Monitoring Survey - ARABIC (for translation service) Other-IVR Telephone Survey Script (Limited number - English for
IVR Active Monitoring Survey - FRENCH Other-IVR Telephone Survey Script - French
IVR Active Monitoring Survey - ENGLISH Other-IVR Telephone Survey Script - English
Ebola Entry Screening Risk Assessment - ARABIC Form and Instruction
Ebola Entry Screening Risk Assessment - FRENCH Form and Instruction
Ebola Entry Screening Risk Assessment - ENGLISH Form and Instruction
United States Traveler Health Declaration - ARABIC Form and Instruction
United States Traveler Health Declaration - FRENCH Form and Instruction
United States Traveler Health Declaration - ENGLISH Form and Instruction
Air Travel Illness or Death Investigation Form
Land Travel Illness or Death Investigation Form
International Maritime Conveyance Illness or Death Investigation Form Form and Instruction