OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 200909-0920-012 · OMB 0920-0821 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Air Travel Illness or Death Investigation Form Modified Available
Land Border Illness or Death Investigation Form Modified Available
International Maritime Illness or Death Report Form Modified Repair queued
International Maritime Illness or Death Investigation Form Modified Available
Q-station illness forms_IRB determination.pdf Supplementary Document Uploaded 2009-09-17 Available
Attachment L - RE public comment on federal register attached below in ful l- 08AW.htm Supplementary Document Uploaded 2009-09-17 Available
Attachment G - 60d FRN.pdf Supplementary Document Uploaded 2009-09-17 Available
Attachment F - Summary of Response Forms.doc Supplementary Document Uploaded 2009-09-17 Available
Attachment E - Quarantine_Station_Contact_List.pdf Supplementary Document Uploaded 2009-09-17 Available
Attachment D - 42cfr71.31Subpart D.pdf Supplementary Document Uploaded 2009-09-17 Available
Attachment C - Critieria for Ill Person Reporting- aviation.pdf Supplementary Document Uploaded 2009-09-17 Available
Attachment B - 42 CFR 71.pdf Supplementary Document Uploaded 2009-09-17 Available
Attachment A- Section 361 PHS Act.doc Supplementary Document Uploaded 2009-09-17 Available
Q Station Illness Forms Supporting Statement - May2009.doc Supporting Statement A Uploaded 2009-09-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188000 Air Travel Illness or Death Investigation Form Modified
187999 Land Border Illness or Death Investigation Form Modified
187998 International Maritime Illness or Death Report Form Modified
187997 International Maritime Illness or Death Investigation Form Modified
ICR Details
0920-0821 200909-0920-012
Historical Active 200906-0920-004
HHS/CDC
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
Existing collection in use without an OMB Control Number   No
Regular
Approved without change 09/21/2009
Retrieve Notice of Action (NOA) 09/17/2009
  Inventory as of this Action Requested Previously Approved
09/30/2012 36 Months From Approved
1,780 0 0
171 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 3 types of ports of entry - air, maritime, and land/border. All forms collect pertinent demographic, clinical and epidemiological information on travelers suspected of being infected with a communicable disease and may be contagious during travel. The forms collect information for follow-up and tracking (surveillance) purposes.
US Code: 42 USC 361 Name of Law: Public Health Services Act
  
None
Not associated with rulemaking
  73 FR 20293 04/15/2008
74 FR 25556 05/28/2009
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,780 0 0 0 0 1,780
Annual Time Burden (Hours) 171 0 0 0 0 171
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$271,102
No
Yes
Uncollected
Uncollected
No
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.
09/17/2009