Information Collection

Optional TB Maritime Contact Investigation Outcome Reporting Form

IC 197944 under ICR 201106-0920-007 · OMB 0920-0900.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0900 can be found here:

Documents and Forms

Document Name Document Type
Att C_Opt TB Maritime CI Outcome Reporting Form.docx Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Optional TB Maritime Contact Investigation Outcome Reporting Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att C_Opt TB Maritime CI Outcome Reporting Form.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 0920-0171, Quarantine and Traveler Related Activities, Including Records for Contact Tracing Investigation and Notification under 42 CFR Parts 70 and 71	FR Citation: 72 FR 238

Number of Respondents: 190	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	190	190
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.