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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0900
ICR Reference No:
201502-0920-008
Status:
Historical Active
Previous ICR Reference No:
201407-0920-002
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Contact investigation Outcome Reporting Forms
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
06/22/2015
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/03/2015
Terms of Clearance:
When the Ebola outbreak ends, CDC should submit a change request to remove those forms from this ICR. Addtionally, in the context of an emergency response, like forms for additional diseases may be added as non-substantive changes.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2018
36 Months From Approved
10/31/2017
Responses
6,457
0
4,577
Time Burden (Hours)
783
0
783
Cost Burden (Dollars)
0
0
0
Abstract:
Section 361 of the Public Health Service Act (42 USC 264) authorizes the Secretary of Health and Human Services to make and enforce regulations necessary to prevent the introduction, transmission or spread of communicable diseases from foreign countries into the United States. This is a request to revise the data collection forms after extensive review. The package includes forms for contact investigations of individuals who may have come into contact with travelers that are confirmed to have Ebola infection.
Authorizing Statute(s):
US Code:
42 USC 264
Name of Law: The Public Health and Welfare
US Code:
42 USC 70-71
Name of Law: Quarantine, Inspection, Licensing
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 74099
12/15/2014
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 9725
02/24/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
Cruise Ship General Outcome Reporting -Maritime (Word & Excel)
none, none
General Reporting Maritime (Excel)
,
General Reporting Maritime (Word)
Cruise Ship Measles Outcome Reporting - Maritime (Word & Excel)
none, none
Measles Maritime (Word)
,
Measles Maritime (Excel)
Cruise Ship Rubella Outcome Reporting - Maritime (Word & Excel)
none, none
Rubella Maritime (Word)
,
Rubella Maritime (Excel)
Cruise Ship TB Outcome Reporting - Maritime (Word & Excel)
none, none
TB Maritime Word
,
TB Maritime (Excel)
Ebola Airline Exposure Assessment Airport or other Staff
none
Ebola Airline Exposure Assessment Airport or Other Staff
Ebola Airline Exposure Assessment Cleaning Staff
none
Ebola Airline Exposure Assessment Cleaning Staff
Ebola Airline Exposure Assessment Flight Crew
none
Ebola Airline Exposure Assessment Flight Crew
Ebola Airline Exposure Assessment Passenger
none
Ebola Airline Exposure Assessment Passenger
Ebola Exposure Questionnaire for Airline Passengers
None
Ebola Exposure Questionnaire for Airline Passengers
Ebola Exposure Questionnaire for Airport Staff
None
Ebola Exposure Questionnaire for Airport Staff
Ebola Exposure Questionnaire for Cleaning Crew
None
Ebola Exposure Questionnaire for Cleaninig Crew
Ebola Exposure Questionnaire for Flight Crew
None
Ebola Exposure Questionnaire for Flight Crew
Ebola Exposure Questionnaire for Passengers on Other Commercial Conveyances
None
Ebola Exposure Questionnaire for Passengers of Other Commercial Conveyances
Script for DGMQ HotLine - Introduction
None
Script for DGMQ HotLine - Introduction, Flight and Seat Confirmation Ebola Air Contact Investigation
State/Local General Outcome Reporting (Air)
none
General Contact Investigation - Air
State/Local General Outcome Reporting (Land)
none
General Contact Reporting (Land)
State/Local Measles Outcome Reporting (Air)
none
Measles (Air)
State/Local Rubella Outcome Reporting (Air)
none
Rubella (Air)
State/Local TB Outcoming Reporting (Air)
none
TB Reporting (Air)
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
6,457
4,577
0
1,880
0
0
Annual Time Burden (Hours)
783
783
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
ICR Revision for 0920-0900 contains addition of Ebola Questionnaires as well as additional forms.
Annual Cost to Federal Government:
$1,349,465
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
03/03/2015
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