OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201207-0920-003 · OMB 0920-0821 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Air Travel Illness or Death Investigation Form Modified Available
Land Travel Illness or Death Investigation Form Modified Available
Maritime Conveyance Illness or Death Investigation Form and Instruction Modified Available
0821 Illness Response Forms Renewal Part B 3_28_12.docx Supporting Statement B Uploaded 2012-07-02 Available
Attachment F - Quarantine-Stations-Jurisdictions.pdf Supplementary Document Uploaded 2012-07-02 Available
Attachment E - 42 CFR Part 71.31Subpart D.pdf Supplementary Document Uploaded 2012-07-02 Available
Attachment D Revised Ill Person Reporting.docx Supplementary Document Uploaded 2012-07-02 Repair queued
Attachment C - Critieria for Ill Person Reporting- aviation.pdf Supplementary Document Uploaded 2012-07-02 Available
Attachment B 42 CFR Part 70 and 71.pdf Supplementary Document Uploaded 2012-07-02 Available
Attachment A- Section 361 PHS Act.doc Supplementary Document Uploaded 2012-07-02 Available
Attachment J 0920-0821 60 day.pdf Supplementary Document Uploaded 2012-07-02 Available
0821 Illness Response Forms Renewal Part A 6_27_12.doc Supporting Statement A Uploaded 2012-07-02 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188000 Air Travel Illness or Death Investigation Form Modified
187999 Land Travel Illness or Death Investigation Form Modified
187997 Maritime Conveyance Illness or Death Investigation Form and Instruction Modified
ICR Details
0920-0821 201207-0920-003
Historical Inactive 201012-0920-003
HHS/CDC
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
Revision of a currently approved collection   No
Regular
Improperly submitted and continue 07/13/2012
Retrieve Notice of Action (NOA) 07/11/2012
  Inventory as of this Action Requested Previously Approved
09/30/2012 36 Months From Approved 09/30/2012
3,758 0 3,758
439 0 439
0 0 0
Quarantine Station staff work in partnership with international, federal, state and local agencies and organizations to fulfill their mission to reduce morbidity and mortality among immigrants, refugees, travelers, expatriates, and other globally mobile persons.
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
  77 FR 24210 04/23/2012
77 FR 40360 07/09/2012
No
No
Yes
Changing Forms
This revision includes a decrease in burden due to improved form organization and question clarity.
$13,398
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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.
07/11/2012