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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
Modified
1800
150
0
Form
none
Air Travel Illness or Death Investigation
Ebola Entry Screening Risk Assessment (Ill Traveler Interview)
Removed
0
0
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
Removed
0
0
0
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - Arabic
Ebola Entry Screening Risk Assessment - ENGLISH
Removed
0
0
0
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - English
Ebola Entry Screening Risk Assessment - FRENCH
Removed
0
0
0
Form and Instruction
None
Ebola Entry Screening Risk Assessment Form - French
IVR Active Monitoring Survey - ARABIC (for translation service)
Removed
0
0
0
Other-IVR Telephone Survey Script (Limited number - English for translation services)
IVR Active Monitoring Survey - ENGLISH
Removed
0
0
0
Other-IVR Telephone Survey Script - English
IVR Active Monitoring Survey - FRENCH
Removed
0
0
0
Other-IVR Telephone Survey Script - French
International Maritime Conveyance Illness or Death Investigation Form
Modified
750
63
0
Form and Instruction
NA
Maritime Conveyance Illness or Death Investigation Form 0821_0134
Land Travel Illness or Death Investigation
Modified
100
8
0
Form
none
Land Travel Illness or Death Investigation
United States Traveler Health Declaration - ARABIC
Removed
0
0
0
Form and Instruction
None
United States Traveler Health Declaration - Arabic Translation Guide
United States Traveler Health Declaration - ENGLISH
Removed
0
0
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
Removed
0
0
0
Form and Instruction
None
United States Traveler Health Declaration - French Translation Guide
Total burden requested under this ICR:
2650
221
0
To view an IC, click on IC Title