Restrictions on Interstate Travel of Persons

Forms and Documents

Document Name	Status
42 CFR 70.3 Applicant to State of Destination for a Permit Form	Removed
Passenger Locator Form (Domestic) Form	New
42 CFR 70.4 Copy of Material submitted to Health Authority Form	Removed
42 CFR 70.4 Report of Communcable Disease While in Interstate Travel by Master of Vessel Form	Modified
42 CFR 70.3 Permit Issued by State Health Authority Form	Removed
42 CFR 70.5 Application to Move from State to State - Communicable Period - Attending Physician Form	Removed
42 CFR 70.5 Application to Move from State to State - Communicable Period - Traveler Form	Removed
42 CFR 70.4 Copy of Materials for State or Local Health Authority Form	Removed
42 CFR 70.4 Report by Master Vessel or Person in Charge of Conveyance Form	Removed
42 CFR 70.3 Copy of Materials - Attending Physician Form	Removed
Attachment 4 Privacy Impact Assessment.pdf Supplementary Document	2016-04-29
Attachment 5 0920-0488 CDC Non-research determination.pdf Supplementary Document	2016-04-29
Attachment 3 CDC FAA Memorandum of Agreement.pdf Supplementary Document	2016-04-29
Interstate Travel_0920-0488_Supporting_Statement B_04292016 clean.doc Supporting Statement B	2016-04-29
Interstate Travel_0920-0488_Supporting_Statement A_04292016 clean.doc Supporting Statement A	2016-04-29
Attachment 5 0920-0488 CDC Non-research determination.pdf Supplementary Document	2015-12-03
Attachment 4 Privacy Impact Assessment.pdf Supplementary Document	2015-12-03
Attachment 1C 42 CFR 70.pdf Supplementary Document	2015-12-03
Attachment 1B 42 CFR 71.pdf Supplementary Document	2015-12-03
Attachment 1A Section 361 of the Public Health Service Act (42 USC 264).pdf Supplementary Document	2015-12-03
Attachment 2 60 day published.pdf Supplementary Document	2015-12-03

IC Document Collections

IC ID	Document Title	Status
6924	42 CFR 70.3 Applicant to State of Destination for a Permit Form	Removed
219176	Passenger Locator Form (Domestic) Form	New
205724	42 CFR 70.4 Copy of Material submitted to Health Authority Form	Removed
205723	42 CFR 70.4 Report of Communcable Disease While in Interstate Travel by Master of Vessel Form	Modified
185660	42 CFR 70.3 Permit Issued by State Health Authority Form	Removed
185659	42 CFR 70.5 Application to Move from State to State - Communicable Period - Attending Physician Form	Removed
185658	42 CFR 70.5 Application to Move from State to State - Communicable Period - Traveler Form	Removed
185657	42 CFR 70.4 Copy of Materials for State or Local Health Authority Form	Removed
185656	42 CFR 70.4 Report by Master Vessel or Person in Charge of Conveyance Form	Removed
185655	42 CFR 70.3 Copy of Materials - Attending Physician Form	Removed

ICR Details

OMB Control No: 0920-0488	ICR Reference No: 201512-0920-001
Status: Historical Active	Previous ICR Reference No: 201302-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 18756
Title: Restrictions on Interstate Travel of Persons
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/09/2016
	Date Received in OIRA: 12/10/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved	05/31/2016
Responses	1,000	0	16,900
Time Burden (Hours)	90	0	3,701
Cost Burden (Dollars)	0	0	0

---

Abstract: The goal of this information collection is to ensure that CDC can collect data related to communicable diseases or deaths that occur aboard conveyances during interstate travel within the United States. This revision request adds one new form and removes other forms that will not be used.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   US Code: 42 USC 70-71 Name of Law: Interstate Quarantine
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 53799	09/08/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 76692	12/10/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
42 CFR 70.4 Copy of Material submitted to Health Authority	none	Restriction on Travel of Persons
42 CFR 70.4 Report of Communcable Disease While in Interstate Travel by Master of Vessel	none	Report by Master or Person in Charge
42 CFR 70.3 Applicant to State of Destination for a Permit	none	Restriction on Travel of Persons
42 CFR 70.3 Copy of Materials - Attending Physician	none	Restriction on Travel of Persons
42 CFR 70.4 Report by Master Vessel or Person in Charge of Conveyance	none	Restriction on Travel of Persons
42 CFR 70.4 Copy of Materials for State or Local Health Authority	none	Restriction on Travel of Persons
42 CFR 70.5 Application to Move from State to State - Communicable Period - Traveler	none	Restriction on Travel of Persons
42 CFR 70.5 Application to Move from State to State - Communicable Period - Attending Physician	none	Restriction on Travel of Persons
Passenger Locator Form (Domestic)	none	Passenger Locator
42 CFR 70.3 Permit Issued by State Health Authority	none	Restriction on Travel of Persons

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,000	16,900	0	-15,900	0	0
Annual Time Burden (Hours)	90	3,701	0	-3,611	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This revision requests the addition of one form and removes others that will not be used. There is an overall reduction in burden and respondents.

---

Annual Cost to Federal Government: $334,837

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/10/2015

---