OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Emergency Submission for Active Monitoring of Travelers Coming from Ebola-affected Countries and Their Contacts Currently Residing in State, Territorial, and Local Jurisdictions

ICR 201503-0920-019 · OMB 0920-1066 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Weekly Active Monitoring - web Form New Available
Daily Active Monitoring Tracking Report - web Form New Available
Daily Active Monitoring Tracking Report - excel Form New Repair queued
SCTF AM-DAM EmergReq SS_B 20150330clean.docx Supporting Statement B Uploaded 2015-04-01 Available
SCTF AM-DAM EmergReq SS_A 20150519-trackedchanges.doc Supporting Statement A Uploaded 2015-05-20 Repair queued
AttJ - NACCHO OMB Review clean.docx Supplementary Document Uploaded 2015-03-30 Repair queued
AttI - ASTHO OMB Review clean.docx Supplementary Document Uploaded 2015-03-30 Available
AttH - CDC Ebola Assist Memo for State.pdf Supplementary Document Uploaded 2015-03-30 Repair queued
AttB - Interim US Guid Ebola Monit Move.pdf Supplementary Document Uploaded 2015-03-30 Available
AttA - Authorizing Legislation.pdf Supplementary Document Uploaded 2015-03-30 Available
IC Document Collections
IC IDCollectionTypeStatusForm
215921 Weekly Active Monitoring - web Form New
215920 Daily Direct Active Monitoring Tracking Report - email Instruction New
215919 Daily Active Monitoring Tracking Report - web Form New
215918 Daily Active Monitoring Tracking Report - excel Form New
ICR Details
0920-1066 201503-0920-019
Historical Active
HHS/CDC 15GG
Emergency Submission for Active Monitoring of Travelers Coming from Ebola-affected Countries and Their Contacts Currently Residing in State, Territorial, and Local Jurisdictions
Existing collection in use without an OMB Control Number   No
Emergency 04/15/2015
Approved with change 05/29/2015
Retrieve Notice of Action (NOA) 04/01/2015
This ICR is approved for six months -- justification related to a public health need will need to be provided at that time for continued collection of the data. Once data collection stops, CDC should discontinue this ICR.
  Inventory as of this Action Requested Previously Approved
11/30/2015 6 Months From Approved
12,958 0 0
1,181 0 0
0 0 0
The goal of this study is to allow CDC to effectively complement ongoing international and travel-related efforts at rapid case identification, contact tracing, and infection control of Ebola Virus Disease in partnership with key respondents who are 62 state and local health departments. The intended use of the data/information collected is to a assure that all persons returning from countries affected by the current Ebola outbreak are being actively monitored.
Emergency clearance is requested to maintain and support direct active and active monitoring of travelers from Ebola-affected countries and healthcare workers who are treating patients with Ebola Virus Disease in the U.S. Disruption of this information collection could impact public health and healthcare providers.
US Code: 42 USC 241 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 12,958 0 0 0 0 12,958
Annual Time Burden (Hours) 1,181 0 0 0 0 1,181
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$84,882
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.
04/01/2015