OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0920-0821 · HHS/CDC.

OMB 0920-0821

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Ebola Entry Screening Risk Assessment (Ill Traveler Interview)Form and Instruction
Ebola Entry Screening Risk Assessment - ARABICForm and Instruction
Ebola Entry Screening Risk Assessment - FRENCHForm and Instruction
Ebola Entry Screening Risk Assessment - ENGLISHForm and Instruction
United States Traveler Health Declaration - ARABICForm and Instruction
United States Traveler Health Declaration - FRENCHForm and Instruction
United States Traveler Health Declaration - ENGLISHForm and Instruction
Air Travel Illness or Death InvestigationForm
Land Travel Illness or Death InvestigationForm
International Maritime Conveyance Illness or Death Investigation FormForm and Instruction
0920-0821 Revision Part B 02182016.docxSupporting Statement B
0920-0821 Revision Part A 02182016.docSupporting 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

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201601-0920-011 Revision of a currently approved collection 2016-03-01 Approved with change
201502-0920-002 Revision of a currently approved collection 2015-02-11 Approved without change
201409-0920-006 No material or nonsubstantive change to a currently approved collection 2014-09-08 Approved with change
201304-0920-005 No material or nonsubstantive change to a currently approved collection 2013-04-04 Approved without change
201207-0920-012 Revision of a currently approved collection 2012-07-27 Approved without change
201207-0920-003 Revision of a currently approved collection 2012-07-11 Improperly submitted and continue
201103-0920-009 No material or nonsubstantive change to a currently approved collection 2011-03-28 Improperly submitted and continue
201012-0920-003 No material or nonsubstantive change to a currently approved collection 2010-12-09 Approved without change
201007-0920-003 No material or nonsubstantive change to a currently approved collection 2010-07-22 Withdrawn and continue
200909-0920-012 Existing collection in use without an OMB Control Number 2009-09-17 Approved without change
200906-0920-004 Existing collection in use without an OMB Control Number 2009-06-11 Improperly submitted
200902-0920-003 New collection (Request for a new OMB Control Number) 2009-02-09 Improperly submitted