Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(CREW) 72-hour Food/Activity History Template (AGE cases) Modified 18000 3000 0 Form 0920-26-0121
(Passenger) 72-hour Food/Activity History Template (AGE cases) Modified 45000 7500 0 Form and Instruction 0920-1260
AGE Illness Report 24 hours before arrival (phone/email/fax) Modified 900 45 0 Form and Instruction 0920-1260
AGE Illness Report 24 hours before arrival (web) Modified 8100 405 0 Form and Instruction 0920-1260
Form 0920-26-0121
AGE Illness Report 4 hours before arrival (phone/email/fax) Modified 720 36 0 Form and Instruction 0920-1260
AGE Illness Report 4 hours before arrival (web) Modified 6480 320 0 Form and Instruction 0920-1260
Daily Reports of AGE Logs Modified 2160 108 0 Form and Instruction 0920-1260
Form 0920-26-0121
Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew) Modified 180000 15000 0 Form and Instruction 0920-1260
Last Symptom Check and Return to Work Clearance (food and nonfood employees) Modified 18000 900 0 Form and Instruction 0920-1260
Recordkeeping of AGE Surveillance Records Unchanged 300 2628000 0 Form and Instruction 0920-1260
Recordkeeping of Engineering and Sanitation Records Unchanged 300 2628000 0 Form and Instruction 0920-1260
Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax) Modified 720 36 0 Form and Instruction 092-1260
Three-day Pre-embarkation AGE Illness Assessment (all crew members) Unchanged 9720000 486000 0 Form and Instruction 0920-1260
Total burden requested under this ICR: 10000680 5769350 0  
To view an IC, click on IC Title