Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Cruise Ship General Outcome Reporting -Maritime (Word & Excel) Removed 0 0 0 Form none General Reporting Maritime (Excel)
Form none General Reporting Maritime (Word)
Cruise Ship Measles Outcome Reporting - Maritime (Word & Excel) Removed 0 0 0 Form none Measles Maritime (Word)
Form none Measles Maritime (Excel)
Cruise Ship Rubella Outcome Reporting - Maritime (Word & Excel) Removed 0 0 0 Form none Rubella Maritime (Word)
Form none Rubella Maritime (Excel)
Cruise Ship TB Outcome Reporting - Maritime (Word) Modified 15 5 187 Form n/a Clinically Active TB Contact Investigation Outcome Reporting Form - Maritime
Ebola Exposure Questionnaire for Airline Passengers Removed 0 0 0 Form and Instruction None Ebola Exposure Questionnaire for Airline Passengers
Ebola Exposure Questionnaire for Airport Staff Removed 0 0 0 Form and Instruction None Ebola Exposure Questionnaire for Airport Staff
Ebola Exposure Questionnaire for Cleaning Crew Removed 0 0 0 Form and Instruction None Ebola Exposure Questionnaire for Cleaninig Crew
Ebola Exposure Questionnaire for Flight Crew Removed 0 0 0 Form and Instruction None Ebola Exposure Questionnaire for Flight Crew
Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances Removed 0 0 0 Form and Instruction None Ebola Exposure Questionnaire for Passengers of Other Commercial Conveyances
Influenza-like Illness Investigation Outcome Reporting Form - Maritime New 45 15 561 Form n/a Influenza-like Illness Investigation Outcome Reporting Form
Script for DGMQ HotLine - Introduction Removed 0 0 0 Form and Instruction None Script for DGMQ HotLine - Introduction, Flight and Seat Confirmation Ebola Air Contact Investigation
State/Local General Contact Reporting (Land) Modified 15 1 47 Form n/a General Contact Investigation Outcome Reporting Form (Land)
State/Local General Outcome Reporting (Air) Modified 34 3 106 Form n/a General Contact Investigation Outcome Reporting Form - Air
State/Local Measles Outcome Reporting (Air) Modified 324 27 1008 Form 0920-0900 Measles Air Contact Investigation Outcome Reporting Form
Form n/a Measles Contact Investigation Outcome Reporting Form - Air
State/Local Rubella Outcome Reporting (Air) Modified 27 2 84 Form n/a Rubella Contact Investigation Outcome Reporting Form - Air
State/Local TB Outcoming Reporting (Air) Modified 547 46 1701 Form n/a TB Contact Investigation Outcome Reporting Form - Air
Varicella Investigation Outcome Reporting Form New 29 10 361 Form n/a Varicella Investigation Outcome Reporting Form
Total burden requested under this ICR: 1036 109 4055  
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