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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Air Travel Illness or Death Investigation
Unchanged
1626
136
0
Form
none
Air Travel Illness or Death Investigation
Ebola Entry Screening Risk Assessment (Ill Traveler Interview)
New
100
25
0
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - English
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - French
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - Arabic
Ebola Entry Screening Risk Assessment - ARABIC
New
13
3
0
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - Arabic
Ebola Entry Screening Risk Assessment - ENGLISH
New
3447
862
0
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - English
Ebola Entry Screening Risk Assessment - FRENCH
New
111
28
0
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - French
Exposure Risk Assessment for Travelers from Ebola-Affected Countries
Removed
0
0
0
Form
none
Risk Assessment for Travelers from Ebola-Affected Countries
IVR Active Monitoring Survey - ARABIC (for translation service)
New
3696
246
0
Other-IVR Telephone Survey Script (Limited number - English for translation services)
IVR Active Monitoring Survey - ENGLISH
New
1033998
68933
0
Other-IVR Telephone Survey Script - English
IVR Active Monitoring Survey - FRENCH
New
33306
2220
0
Other-IVR Telephone Survey Script - French
International Maritime Illness or Death Investigation
Unchanged
1873
156
0
Form and Instruction
0920-0821
Attachment A Maritime investigation form
Land Travel Illness or Death Investigation
Unchanged
259
22
0
Form
none
Land Travel Illness or Death Investigation
United States Traveler Health Declaration - ARABIC
New
176
44
0
Form and Instruction
None
United States Traveler Health Declaration - Arabic Translation Guide
United States Traveler Health Declaration - ENGLISH
New
49238
12310
0
Form and Instruction
None
United States Traveler Health Declaration - English/Hard Copy
Form and Instruction
None
United States Traveler Health Declaration - English/Portal
Form and Instruction
None
United States Health Declaration - English/PDF
United States Traveler Health Declaration - FRENCH
New
1586
397
0
Form and Instruction
None
United States Traveler Health Declaration - French Translation Guide
Total burden requested under this ICR:
1129429
85382
0
To view an IC, click on IC Title