Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)

Forms and Documents

Document Name	Status
Passenger Locator Form - domestic flights Form	Unchanged
Passenger Locator Form - limited onboard exposure int'l flights Form	Unchanged
Passenger Locator Form - outbreak of PH significance int'l flights Form	Modified
0920-1181 RWA PLF Change 03042020 omb DGMQ Clean.docx Justification for No Material/Nonsubstantive Change	2020-03-04
Attachment 13 System of Record Notice.pdf Supplementary Document	2017-05-03
Attachment 12 Approval for Removal of Expiration Date.pdf Supplementary Document	2016-11-02
Attachment 10 Receipt of manifest letter.doc Supplementary Document	2016-11-02
Attachment 8 IATA Passenger Manifest Information Request Form.pdf Supplementary Document	2016-11-02
Attachment 7 Order Cover Letter.doc Supplementary Document	2016-11-02
Attachment 4 CDC Nonresearch determination Letter.pdf Supplementary Document	2016-10-31
Attachment 3 QARS Privacy Impact Assessment.pdf Supplementary Document	2016-10-31
Attach 2 PLF 60 day 9.2.16.pdf Supplementary Document	2016-10-31
Attachment 1C 42 CFR part 70.pdf Supplementary Document	2016-10-31
Attachment 1B 42 CFR part 71.pdf Supplementary Document	2016-10-31
Attachment 1A Section 361 of the Public Health Service Act (42 USC 264).docx Supplementary Document	2016-10-31
0920-XXXX_Domestic Manifest PLF Supporting Statement Part B.doc Supporting Statement B	2016-10-31
Domestic Manifest PLF Supporting Statement Part A 04242017.doc Supporting Statement A	2017-05-03

IC Document Collections

IC ID	Document Title	Status
224286	Passenger Locator Form - domestic flights Form	Unchanged
224285	Passenger Locator Form - limited onboard exposure int'l flights Form	Unchanged
224284	Passenger Locator Form - outbreak of PH significance int'l flights Form	Modified
224253	Domestic non-TB Manifest Template and Informal Manifest Request Instruction	Unchanged
224252	Domestic TB Manifest Template or Informal Manifest Request Instruction	Unchanged

ICR Details

OMB Control No: 0920-1181	ICR Reference No: 202003-0920-003
Status: Historical Inactive	Previous ICR Reference No: 201610-0920-015
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Airline and Traveler Information Collection: Domestic Manifests and the Passenger Locator Form (42 CFR Part 70 and 71)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 05/13/2020
	Date Received in OIRA: 03/04/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	05/31/2020	01/31/2021
Responses	2,701,629	0	2,701,629
Time Burden (Hours)	225,308	0	225,308
Cost Burden (Dollars)	0	0	0

---

Abstract: This information collection ensures that, consistent with the authorities in the Public Health Service Act and in Code of Federal Regulations (CFR), CDC can collect conveyance, passenger and crew member manifest information (manifests) and Passenger Locator Forms (PLF) in the event an individual with a confirmed or suspected case of a communicable disease is known to have traveled on an interstate flight while infectious or potentially infectious and presented a risk of spread to other passengers or crew. This is collected so CDC can initiate the process of contact tracing or provision of other public health follow up to prevent further disease spread. The Non-Substantive Change Request, is submitted for the addition of a web-based version of the PLF.

---

Authorizing Statute(s): Statute at Large: 42 Stat. 70 Name of Statute: Interstate Quarantine
   Statute at Large: 42 Stat. 71 Name of Statute: Foreign Quarantine
   US Code: 42 USC 264 Name of Law: Public Health and Welfare
  

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:
	81 FR 60702	09/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 78165	11/07/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Domestic TB Manifest Template or Informal Manifest Request
Domestic non-TB Manifest Template and Informal Manifest Request
Passenger Locator Form - limited onboard exposure int'l flights	none	Passenger Locator Form
Passenger Locator Form - domestic flights	none	Passenger Locator Form
Passenger Locator Form - outbreak of PH significance int'l flights	none, 0920-1181	Passenger Locator Form ,   Passenger Locator Form (Web-based)

---

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $355,282

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

---

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: 03/04/2020

---