OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201012-0920-003 · 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 Removed Repair queued
International Maritime Illness or Death Investigation Form Modified Repair queued
Q Station Illness Forms Change Supporting Statementredline111610.doc Supplementary Document Uploaded 2010-11-18 Available
Attachment C Summary of Form Changes rev.docx Supplementary Document Uploaded 2010-11-18 Available
Attachment B - 42 CFR 71.pdf Supplementary Document Uploaded 2010-11-18 Available
Attachment A- Section 361 PHS Act.doc Supplementary Document Uploaded 2010-11-18 Available
Attachment D Justification (2).docx Justification for No Material/Nonsubstantive Change Uploaded 2010-11-18 Repair queued
Q Station Illness Forms Change Supporting StatementClean111610.doc Supporting Statement A Uploaded 2010-11-18 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 Removed
187997 International Maritime Illness or Death Investigation Form Modified
ICR Details
0920-0821 201012-0920-003
Historical Active 200909-0920-012
HHS/CDC
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 12/09/2010
Retrieve Notice of Action (NOA) 12/09/2010
  Inventory as of this Action Requested Previously Approved
09/30/2012 09/30/2012 09/30/2012
3,758 0 1,780
439 0 171
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
   US Code: 42 USC 71 Name of Law: Foreign Quarantine
  
None
Not associated with rulemaking
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 3,758 1,780 0 1,978 0 0
Annual Time Burden (Hours) 439 171 0 268 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
The increase in burden is due to the increased number of respondents which is largely beyond the control of CDC. The reduction in burden is due to combining the two maritime forms into one.
$271,102
No
Yes
No
No
No
Uncollected
Carol Walker 4046394773
  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.
12/09/2010