Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(CREW) 72-hour Food/Activity History Template (AGE cases) New 17250 2875 0 Form and Instruction 0920-1260
(Passenger) 72-hour Food/Activity History Template (AGE cases) New 83850 13975 0 Form and Instruction 0920-1260
71.21 (c) 72-hour food/activity history - AGE Passenger and Crew cases Removed 0 0 0 Form and Instruction NA
71.21 (c) AGE Logs Removed 0 0 0 Form and Instruction NA
71.21 (c) Documentation of 3-day pre-embarkation AGE illness assessment for all crew members Removed 0 0 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 Removed 0 0 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 Removed 0 0 0 Form and Instruction NA
71.21 (c) Recordkeeping - medical records (72-hour food/activity history) Removed 0 0 0 Form and Instruction NA
71.21 (c) Recordkeeping – medical records (AGE Logs) Removed 0 0 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) Removed 0 0 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) Removed 0 0 0 Form and Instruction NA
71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS) Removed 0 0 0 Form and Instruction NA
Form and Instruction NA
71.21(c) Recordkeeping - Gastrointestinal Illnesses Report 24 and 4 hours before arrival Removed 0 0 0 Form and Instruction NA
71.21(c) Recordkeeping - medical records (Documentation of 3-day pre-embarkation AGE illness assessment for all crew members) Removed 0 0 0 Form and Instruction NA
AGE Illness Report 24 hours before arrival (phone/email/fax) New 5040 252 0 Form and Instruction 0920-1260
AGE Illness Report 24 hours before arrival (web) New 3960 198 0 Form and Instruction 0920-1260
AGE Illness Report 4 hours before arrival (phone/email/fax) New 4020 201 0 Form and Instruction 0920-1260
AGE Illness Report 4 hours before arrival (web) New 3180 159 0 Form and Instruction 0920-1260
Daily Reports of AGE Logs New 2160 108 0 Form and Instruction 0920-1260
Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew) New 251550 21562 0 Form and Instruction 0920-1260
Last Symptom Check and Return to Work Clearance (food and nonfood employees) New 17250 862 0 Form and Instruction 0920-1260
Recordkeeping of AGE Surveillance Records New 300 2628000 0 Form and Instruction 0920-1260
Recordkeeping of Engineering and Sanitation Records New 300 2628000 0 Form and Instruction 0920-1260
Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax) New 720 36 0 Form and Instruction 092-1260
Three-day Pre-embarkation AGE Illness Assessment (all crew members) New 9720000 486000 0 Form and Instruction 0920-1260
Total burden requested under this ICR: 10109580 5782228 0  
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