Information Collection

Ebola Exposure Questionnaire for Cleaning Crew

IC 215020 under ICR 201510-0920-003 · OMB 0920-0900.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0900 can be found here:

Documents and Forms

Document Name Document Type
Ebola Exposure Questionnaire for Cleaning Crew Form and Instruction
Ebola Exposure Questionnaire for Cleaninig Crew Attachment R ExposureQuestionnaire_CleaningCrew.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ebola Exposure Questionnaire for Cleaning Crew	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Ebola Exposure Questionnaire for Cleaninig Crew	Attachment R ExposureQuestionnaire_CleaningCrew.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine- and Traveler-Related Activities	FR Citation: 72 FR 7086

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.