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  
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