Information Collection

Passenger Locator Form - domestic flights

IC 224286 under ICR 201610-0920-015 · OMB 0920-1181.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1181 can be found here:

Documents and Forms

Document Name Document Type
Passenger Locator Form - domestic flights Form
Passenger Locator Form Attachment 11 Public Health Passenger Locator Form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Passenger Locator Form - domestic flights	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR PHSA 42 CFR Foreign Quarantine Reg part 70 42 CFR Foreign Quarantine Reg part 71 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Passenger Locator Form	Attachment 11 Public Health Passenger Locator Form.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Quarantine and Traveler Related Activities Including Records for Contact Tracing Investigation and Notification	FR Citation: 72 FR 239

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	67	67
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.