View Information Collection (IC)

View Information Collection (IC)

IC Title:	United States Traveler Health Declaration - ENGLISH	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	None	United States Traveler Health Declaration - English/Hard Copy	Attachment F1a 2015 01 23 Health Declaration clean.doc	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	United States Traveler Health Declaration - English/Portal	Attachment F1b United States Traveler Health Declaration - Portal.png	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	United States Health Declaration - English/PDF	Attachment F1c 2015 01 12 Health Declaration - Fillable PDF.PDF	None	Yes	Yes	Fillable Fileable

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	FR Citation: 72 FR 7086

Number of Respondents: 49,238	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	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	0	0	-49,238	0	0	49,238
Annual IC Time Burden (Hours)	0	0	-12,310	0	0	12,310
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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