OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Emergency Submission to Supplement OMB Control Number 0920-0900 in Context of Contact Investigations Associated with Ebola and Travel

ICR 201411-0920-006 · OMB 0920-1032 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Ebola Questionnaire for Passengers on Other Commercial Conveyances Form New Available
Ebola Exposure Questionnaire for Airport Staff Form New Available
Ebola Exposure Questionnaire for Cleaning Crew Form New Available
Ebola Exposure Questionnaire for Flight Crew Form New Available
Ebola Exposure Questionnaire for Airline Passengers Form New Available
Airport or Other Port of Entry Staff Assessment Form Removed Available
Cleaning Crew Assessment Form Removed Available
Flight Crew Assessment Form Removed Available
Passenger Exposure Assessment Form Removed Repair queued
Script Introduction and Confirmation Form Unchanged Repair queued
Attachment G Risk stratification.docx Supplementary Document Uploaded 2014-11-18 Available
OMB package non-substantive change to Ebola Exposure for Airline Contact Investigation questionnaire.docx Justification for No Material/Nonsubstantive Change Uploaded 2014-11-18 Available
Emergency Request Contact Investigations Part A.doc Supporting Statement A Uploaded 2014-10-16 Available
USCODE-2009-title42-chap6A-subchapII-partG.pdf Supplementary Document Uploaded 2014-10-16 Available
Emergency Request Contact Investigations Part B.docx Supporting Statement B Uploaded 2014-10-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
213971 Ebola Questionnaire for Passengers on Other Commercial Conveyances Form New
213970 Ebola Exposure Questionnaire for Airport Staff Form New
213969 Ebola Exposure Questionnaire for Cleaning Crew Form New
213968 Ebola Exposure Questionnaire for Flight Crew Form New
213967 Ebola Exposure Questionnaire for Airline Passengers Form New
213516 Airport or Other Port of Entry Staff Assessment Form Removed
213515 Cleaning Crew Assessment Form Removed
213514 Flight Crew Assessment Form Removed
213513 Passenger Exposure Assessment Form Removed
213512 Script Introduction and Confirmation Form Unchanged
ICR Details
0920-1032 201411-0920-006
Historical Active 201410-0920-022
HHS/CDC 15BW
Emergency Submission to Supplement OMB Control Number 0920-0900 in Context of Contact Investigations Associated with Ebola and Travel
No material or nonsubstantive change to a currently approved collection   No
Emergency 10/16/2014
Approved without change 11/19/2014
Retrieve Notice of Action (NOA) 11/18/2014
Previous TOC apply.
  Inventory as of this Action Requested Previously Approved
04/30/2015 04/30/2015
34,800 0 33,000
5,349 0 4,749
0 0 0
The Centers for Disease Control and Prevention is requesting emergency clearance to perform contact investigations of individuals who may have come into contact with travelers that are confirmed to have Ebola infection.
Additional information is needed to better assess the risk to individuals who may have been exposed to a confirmed case of Ebola in the U.S.
US Code: 42 USC 70-71 Name of Law: Public Health Service Act
  
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 34,800 33,000 0 1,800 0 0
Annual Time Burden (Hours) 5,349 4,749 0 600 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Changes due to Non-Substantive Emergency Change Request
No
No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [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.
11/18/2014