Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form)) Removed 0 0 0
42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form)) Removed 0 0 0
Air Travel Illness or Death Investigation Form Removed 0 0 0 Form and Instruction 0920-0134
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Removed 0 0 0 Form and Instruction 42CFR 71.21(a)
Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft Removed 0 0 0
Cumulative Influenza/Influenza-Like Illness (ILI) Form Removed 0 0 0 Form and Instruction none
Domestic Land Conveyance Manifest Order Template New 30 45 0 Instruction
General Land Contact Investigation Outcome Reporting Form New 20 3 0 Form and Instruction n/a
International Land Conveyance Manifest Order Template New 10 25 0 Instruction
Land Passenger Locator Form New 210 18 0 Form and Instruction n/a
Land Travel Illness or Death Investigation Form Modified 200 50 0 Form and Instruction none
Maritime Conveyance Illness or Death Investigation Form (Section 5) Removed 0 0 0 Form 0920-25CC
Report by the Master of a Vessel or Person in Charge of Conveyance of the Incidence of a Communicable Disease Occurring While in Interstate Travel New 100 12 0 Other-OMB Header and Burden Statement
TB Land Contact Investigation Outcome Reporting Form New 20 3 0 Form and Instruction n/a
Total burden requested under this ICR: 590 156 0  
To view an IC, click on IC Title