OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201409-0920-006 · OMB 0920-0821 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Exposure Risk Assessment for Travelers from Ebola-Affected Countries Form New Available
Air Travel Illness or Death Investigation Form Unchanged Available
Land Travel Illness or Death Investigation Form Unchanged Available
Form 0920-0821 International Maritime Illness or Death Investigation Form and Instruction Unchanged Available
Non-substantive Change_Quarantine Station Illness Response Forms 0920-08....docx Justification for No Material/Nonsubstantive Change Uploaded 2014-09-18 Available
Non-substantive Change_Quarantine Station Illness Response Forms 0920-0821 09182014.docx Justification for No Material/Nonsubstantive Change Uploaded 2014-09-18 Available
Attachment B 71 21a Other illness reports MIDRS screenshot.pdf Supplementary Document Uploaded 2013-03-29 Available
IC Document Collections
IC IDCollectionTypeStatusForm
213021 Exposure Risk Assessment for Travelers from Ebola-Affected Countries Form New
188000 Air Travel Illness or Death Investigation Form Unchanged
187999 Land Travel Illness or Death Investigation Form Unchanged
187997 International Maritime Illness or Death Investigation Form and Instruction Unchanged
ICR Details
0920-0821 201409-0920-006
Historical Active 201304-0920-005
HHS/CDC 19217
Quarantine Station Illness Response Forms: Airline, Maritime, and Land/Border Crossing
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 09/18/2014
Retrieve Notice of Action (NOA) 09/08/2014
  Inventory as of this Action Requested Previously Approved
08/31/2015 08/31/2015 08/31/2015
3,858 0 3,758
319 0 314
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. This request for change is to add the Exposure Risk Assessment for Travelers from Ebola Outbreak-Affected countries.
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
  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 3,858 3,758 0 100 0 0
Annual Time Burden (Hours) 319 314 0 5 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This request for change is to add the Risk Assessment for Travelers from Ebola-Affected countries as discussed with OMB.
$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.
09/08/2014