View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Passenger Locator Form - domestic flights	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR Foreign Quarantine Reg part 71 42 CFR PHSA 42 CFR Foreign Quarantine Reg part 70 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Passenger Locator Form	Attachment 11 Public Health Passenger Locator Form.pdf		Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Quarantine and Traveler Related Activities Including Records for Contact Tracing Investigation and Notification	FR Citation: 72 FR 239

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	800	0	800	0	0	0
Annual IC Time Burden (Hours)	67	0	67	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.