Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
71.21 (c) 72-hour food/activity history - AGE Passenger and Crew cases New 5000 833 0 Form and Instruction NA
71.21 (c) AGE Logs New 2500 417 0 Form and Instruction NA
71.21 (c) Documentation of 3-day pre-embarkation AGE illness assessment for all crew members New 1250 63 0 Form and Instruction NA
71.21 (c) Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees New 250 13 0 Form and Instruction NA
71.21 (c) Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times New 750 63 0 Form and Instruction NA
71.21 (c) Recordkeeping - medical records (72-hour food/activity history) New 250 4 0 Form and Instruction NA
71.21 (c) Recordkeeping – medical records (AGE Logs) New 250 4 0 Form and Instruction NA
71.21 (c) Recordkeeping – medical records (Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees) New 250 4 0 Form and Instruction NA
71.21 (c) Recordkeeping – medical records (Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times) New 250 4 0 Form and Instruction NA
71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS) New 2500 125 0 Form and Instruction NA
Form and Instruction NA
71.21(c) Recordkeeping - Gastrointestinal Illnesses Report 24 and 4 hours before arrival New 250 4 0 Form and Instruction NA
71.21(c) Recordkeeping - medical records (Documentation of 3-day pre-embarkation AGE illness assessment for all crew members) New 250 4 0 Form and Instruction NA
Total burden requested under this ICR: 13750 1538 0  
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