OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Emergency Submission to Supplement OMB Control Number 0920-0821 in the Context of Active Monitoring of Travelers Coming from Sierra Leone, Liberia, and Guinea

ICR 201410-0920-033 · OMB 0920-1034 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Active Monitoring Survey - French Form and Instruction New Available
Active Monitoring Survey Form and Instruction New Available
Attachment B - CARE wallet card.pdf Supplementary Document Uploaded 2014-10-29 Repair queued
USCODE-2009-title42-chap6A-subchapII-partG.PDF Supplementary Document Uploaded 2014-10-29 Available
0920-0821 Emergency Request Active Monitoring Part B.docx Supporting Statement B Uploaded 2014-10-29 Available
0920-0821 Emergency Request Active Monitoring Part A 10-29-14.doc Supporting Statement A Uploaded 2014-10-29 Available
IC Document Collections
IC IDCollectionTypeStatusForm
213669 Active Monitoring Survey - French Form and Instruction New
213668 Active Monitoring Survey Form and Instruction New
ICR Details
0920-1034 201410-0920-033
Historical Active
HHS/CDC 15CU
Emergency Submission to Supplement OMB Control Number 0920-0821 in the Context of Active Monitoring of Travelers Coming from Sierra Leone, Liberia, and Guinea
New collection (Request for a new OMB Control Number)   No
Emergency 10/31/2014
Approved without change 10/30/2014
Retrieve Notice of Action (NOA) 10/30/2014
  Inventory as of this Action Requested Previously Approved
04/30/2015 6 Months From Approved
574,854 0 0
38,324 0 0
0 0 0
The Centers for Disease Control and Prevention (CDC) has been tasked to support state health departments as they engage in active monitoring of travelers arriving at U.S. airports from countries currently affected by the Ebola outbreak. This data collection will be conducted via a survey administered either through Interactive Voice Response (IVR) phone system or by a live person and will ask travelers if they have developed a fever or any other symptoms potentially indicative of Ebola exposure.
The Centers for Disease Control and Prevention (CDC) has been tasked to support state health departments as they engage in active monitoring of travelers arriving at U.S. airports from countries currently affected by the Ebola outbreak. This data collection will be conducted via a survey administered either through Interactive Voice Response (IVR) phone system or by a live person and will ask travelers if they have developed a fever or any other symptoms potentially indicative of Ebola exposure.
US Code: 42 USC 264G Name of Law: PHSA
  
None
Not associated with rulemaking
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 574,854 0 0 574,854 0 0
Annual Time Burden (Hours) 38,324 0 0 38,324 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is an emergency request to support state health departments as they engage in active monitoring of travelers arriving at U.S. airports from countries currently affected by the Ebola outbreak
$98,387
No
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.
10/30/2014