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Federal forms, ICRs, and supporting documents

Information Collection Request

Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)

ICR 201610-0920-015 · OMB 0920-1181 · Active

Forms and Documents
DocumentTypeStatusAvailability
Passenger Locator Form - domestic flights Form New Repair queued
Passenger Locator Form - limited onboard exposure int'l flights Form New Repair queued
Passenger Locator Form - outbreak of PH significance int'l flights Form New Repair queued
Attachment 13 System of Record Notice.pdf Supplementary Document Uploaded 2017-05-03 Repair queued
Attachment 12 Approval for Removal of Expiration Date.pdf Supplementary Document Uploaded 2016-11-02 Repair queued
Attachment 10 Receipt of manifest letter.doc Supplementary Document Uploaded 2016-11-02 Repair queued
Attachment 8 IATA Passenger Manifest Information Request Form.pdf Supplementary Document Uploaded 2016-11-02 Repair queued
Attachment 7 Order Cover Letter.doc Supplementary Document Uploaded 2016-11-02 Repair queued
Attachment 4 CDC Nonresearch determination Letter.pdf Supplementary Document Uploaded 2016-10-31 Available
Attachment 3 QARS Privacy Impact Assessment.pdf Supplementary Document Uploaded 2016-10-31 Repair queued
Attach 2 PLF 60 day 9.2.16.pdf Supplementary Document Uploaded 2016-10-31 Available
Attachment 1C 42 CFR part 70.pdf Supplementary Document Uploaded 2016-10-31 Available
Attachment 1B 42 CFR part 71.pdf Supplementary Document Uploaded 2016-10-31 Available
Attachment 1A Section 361 of the Public Health Service Act (42 USC 264).docx Supplementary Document Uploaded 2016-10-31 Repair queued
0920-XXXX_Domestic Manifest PLF Supporting Statement Part B.doc Supporting Statement B Uploaded 2016-10-31 Available
Domestic Manifest PLF Supporting Statement Part A 04242017.doc Supporting Statement A Uploaded 2017-05-03 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
224286 Passenger Locator Form - domestic flights Form New
224285 Passenger Locator Form - limited onboard exposure int'l flights Form New
224284 Passenger Locator Form - outbreak of PH significance int'l flights Form New
224253 Domestic non-TB Manifest Template and Informal Manifest Request Instruction New
224252 Domestic TB Manifest Template or Informal Manifest Request Instruction New
ICR Details
0920-1181 201610-0920-015
Active
HHS/CDC 16BBS
Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)
Existing collection in use without an OMB Control Number   No
Regular
Approved with change 05/08/2017
Retrieve Notice of Action (NOA) 11/08/2016
Approved consistent with the understanding that an individual's refusal to be screened or to complete the passenger locator form will not directly result in that individual’s quarantine, isolation, or conditional release. However, if sufficient facts and circumstances exist that would lead a public health officer to reasonably suspect that the individual is infected with a quarantinable communicable disease in its qualifying stage, then that individual may be issued a Federal order for quarantine, isolation, or conditional surveillance.
  Inventory as of this Action Requested Previously Approved
05/31/2020 36 Months From Approved
2,701,629 0 0
225,308 0 0
0 0 0
This information collection ensures that, consistent with the authorities in the Public Health Service Act and in Code of Federal Regulations (CFR), CDC can collect conveyance, passenger and crew member manifest information (manifests) and Passenger Locator Forms (PLF) in the event an individual with a confirmed or suspected case of a communicable disease is known to have traveled on an interstate flight while infectious or potentially infectious and presented a risk of spread to other passengers or crew. This is collected so CDC can initiate the process of contact tracing or provision of other public health follow up to prevent further disease spread.
Statute at Large: 42 Stat. 70 Name of Statute: Interstate Quarantine
   Statute at Large: 42 Stat. 71 Name of Statute: Foreign Quarantine
   US Code: 42 USC 264 Name of Law: Public Health and Welfare
  
None
Not associated with rulemaking
  81 FR 60702 09/02/2016
81 FR 78165 11/07/2016
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 2,701,629 0 0 2,701,629 0 0
Annual Time Burden (Hours) 225,308 0 0 225,308 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a request for approval of an existing collection without an OMB number.
$355,282
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.
11/08/2016