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  
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