Information Collection

Active Monitoring Survey

IC 213668 under ICR 201410-0920-033 · OMB 0920-1034.

Documents and Forms

Document Name Document Type
Active Monitoring Survey Form and Instruction
Active Monitoring Survey - English Attachment A- IVR Script for Active Monitoring _OMB.10-28.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Active Monitoring Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Active Monitoring Survey - English	Attachment A- IVR Script for Active Monitoring _OMB.10-28.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Quarantine and Traveler Related Activities	FR Citation: 72 FR 70867

Number of Respondents: 22,812	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	479,052	479,052
Annual IC Time Burden (Hours)	31,937	31,937
Annual IC Cost Burden (Dollars)	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.