OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

2014E003XXX_MERS-CoV_GA

IC 211682 under ICR 201410-0920-034 · OMB 0920-1011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Document Name Document Type
2014E003XXX_MERS-CoV_GA Form
Questionnaire for Passengers and Crew Appendix A. Telephone Survey.docx Form
Follow-up Questionnaire for Asymptomatic Passengers and Appendix B. Follow-up Telephone Survey.docx Form
2014003XXX_MERS-CoV_GA.docx Request for Approval IC Document
Request for CDC Assistance.msg Invitation for Assistance IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2014E003XXX_MERS-CoV_GA	Agency IC Tracking Number:	14AET

IC Status: Unchanged

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	none	Questionnaire for Passengers and Crew	Appendix A. Telephone Survey.docx		No		Paper Only
Form	none	Follow-up Questionnaire for Asymptomatic Passengers and Crew	Appendix B. Follow-up Telephone Survey.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 186	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	186	0	0	0	0	186
Annual IC Time Burden (Hours)	40	0	0	0	0	40
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	2014003XXX_MERS-CoV_GA.docx	05/22/2014
Invitation for Assistance	Request for CDC Assistance.msg	05/22/2014

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