View Information Collection (IC)

View Information Collection (IC)

IC Title:	International Maritime Illness or Death Investigation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0821	Attachment A Maritime investigation form	Attachment A Maritime investigation form_June22 2012.docx		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine and Traveler Related Activities, including Records for Contact Tracing Investigation and Notification	FR Citation: 72 FR 70867

Number of Respondents: 1,873	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,873	0	0	0	0	1,873
Annual IC Time Burden (Hours)	156	0	0	0	0	156
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment B 71 21a Other illness reports MIDRS screenshot	Attachment B 71 21a Other illness reports MIDRS screenshot.pdf	03/29/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.