OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 200902-0920-003 · OMB 0920-0821 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Form No number Air Travel Illness or Death Investigation Form New Repair queued
Form No number Land Border Illness or Death Investigation Form New Available
Form No number International Maritime Illness or Death Report Form New Available
Form No number International Maritime Illness or Death Investigation Form New Available
Response Matrix - OMB Comment - Illness Response.doc Supplementary Document Uploaded 2009-04-30 Repair queued
Attachment F - Summary of Response Forms rev 04 24 09.doc Supplementary Document Uploaded 2009-04-30 Available
Attachment K - Land Border Crossing of Travelers Form FINAL Burden State2 rev 04 24 09.doc Supplementary Document Uploaded 2009-04-30 Repair queued
Q-station illness forms_IRB determination.pdf Supplementary Document Uploaded 2009-01-22 Available
Attachment L - RE public comment on federal register attached below in ful l- 08AW.htm Supplementary Document Uploaded 2009-01-22 Repair queued
Attachment G - 60d FRN.pdf Supplementary Document Uploaded 2009-01-22 Available
Attachment F - Summary of Response Forms.doc Supplementary Document Uploaded 2009-01-22 Available
Attachment E - Quarantine_Station_Contact_List.pdf Supplementary Document Uploaded 2009-01-22 Repair queued
Attachment D - 42cfr71.31Subpart D.pdf Supplementary Document Uploaded 2009-01-22 Available
Attachment C - Critieria for Ill Person Reporting- aviation.pdf Supplementary Document Uploaded 2009-01-22 Repair queued
Attachment B - 42 CFR 71.pdf Supplementary Document Uploaded 2009-01-22 Available
Attachment A- Section 361 PHS Act.doc Supplementary Document Uploaded 2009-01-22 Available
NEWQ Station Illness Forms Supporting Statement - Jan2009 rev 04 24 09.doc Supporting Statement A Uploaded 2009-04-30 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
188000 Air Travel Illness or Death Investigation Form New
187999 Land Border Illness or Death Investigation Form New
187998 International Maritime Illness or Death Report Form New
187997 International Maritime Illness or Death Investigation Form New
ICR Details
0920-0821 200902-0920-003
Historical Inactive
HHS/CDC
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
New collection (Request for a new OMB Control Number)   No
Regular
Improperly submitted 05/08/2009
Retrieve Notice of Action (NOA) 02/09/2009
According to an agency response to OMB comments, this ICR should have been submitted as “existing collection in use without an OMB Control Number.” The agency must resubmit under the correct classification.
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0
This data collection supports quarantine responsibilities of assessing, detecting, and responding to reports of communicable disease threats of potential public health importance at US ports of entry. The forms are for different ports of entry - air, maritime, and land/border. They collect demographic, clinical, and epidemiologic information on travelers suspected of being infected wtih a communicable disease and contagious during travel.
US Code: 42 USC 361 Name of Law: Regulations to Control Commuicable Disease
  
None
Not associated with rulemaking
  73 FR 20293 04/15/2008
74 FR 4037 01/22/2009
Yes
Yes
Miscellaneous Actions
No
This is a new ICR.
$271,102
No
Yes
Uncollected
Uncollected
Uncollected
Uncollected
Maryam Daneshvar 4046394604
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/09/2009