2022 Ebola Airport Entry Questionnaires

Forms and Documents

Document Name	Status
Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries Form and Instruction	New
EVD Initial Screening Questions Form and Instruction	New
SSA Emergency Clearance 2022 Ebola Entry Risk Assessment_10.6.2022.docx Supporting Statement A	2022-10-07
SSB Emergency Clearance 2022 Entry Risk Questionnaire_10.6.2022.docx Supporting Statement B	2022-10-07
Emergency Review Request Memo - 2022 Ebola Entry Risk Assessment-10.6.2022 (003).pdf Supplementary Document	2022-10-07
Attachment F-IRB Non-Research Determination.pdf Supplementary Document	2022-10-07
Attachment E-QARS PIA.pdf Supplementary Document	2022-10-07
Attachment A2-42 CFR part 71.pdf Supplementary Document	2022-10-07
Attachment A1-42 USC 264.pdf Supplementary Document	2022-10-07

IC Document Collections

IC ID	Document Title	Status
256312	Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries Form and Instruction	New
256311	EVD Initial Screening Questions Form and Instruction	New

ICR Details

OMB Control No: 0920-1375	ICR Reference No: 202210-0920-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-XXXX
Title: 2022 Ebola Airport Entry Questionnaires
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/07/2022
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/07/2022
	Date Received in OIRA: 10/07/2022
Terms of Clearance: OMB is approving this Emergency ICR with the understanding that within 6 months from the approval date, CDC will complete a 60d and 30d public comment request to support the approval of the ICR ahead of the expiration date.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	6 Months From Approved
Responses	59,020	0	0
Time Burden (Hours)	6,259	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: To protect U.S. communities from an imported case of Ebola Virus Disease (EVD), the United States must be prepared to respond domestically by providing state and local health departments and healthcare facilities with the necessary assessments and questionnaires that can assist in identifying symptoms of or high-risk exposures to EVD in travelers arriving from areas affected by the outbreak. CDC will conduct emergency assessments at designated U.S. airports that are receiving travelers from the Ebola outbreak areas in Uganda, with assistance from the Department of Homeland Security. This system of risk assessment and triage will facilitate transmission of information to assist state and local health departments to complete a 21-day follow-up period and prevent introduction and spread of EVD into the United States.

Emergency Justfication: Information collected at U.S. airports is essential to the CDC’s ability to assess risk of symptoms or exposure to Ebola virus disease (EVD) in travelers coming to the United States from areas affected by an outbreak of EVD originating in Uganda. CDC will conduct emergency assessments at designated U.S. airports that are receiving travelers from the outbreak areas, with assistance from the Department of Homeland Security. This system of risk assessment and triage will facilitate transmission of information to assist state and local health departments to complete a 21-day follow-up period and prevent introduction and spread of EVD into the United States. CDC plans to implement these procedures, starting with the 2022 Ebola Airport Entry Questionnaire at U.S. airports beginning Tuesday October 11, 2022. If an emergency approval is not granted, then the spread of Ebola to the United States is more likely.

---

Authorizing Statute(s): US Code: 42 USC 71 Name of Law: Foreign Quarantine
   US Code: 42 USC 264 Name of Law: U.S. PHSA
  

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

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
EVD Initial Screening Questions	NA	INITIAL EBOLA SCREENING SCRIPT
Public Health Assessment For Travelers From Ebola Outbreak-Affected Countries	NA	PUBLIC HEALTH ASSESSMENT FOR TRAVELERS FROM EBOLA OUTBREAK-AFFECTED COUNTRIES

---

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	59,020	0	0	59,020	0	0
Annual Time Burden (Hours)	6,259	0	0	6,259	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: No

Burden Reduction Due to:

Short Statement: Emergency ICR submitted for Ebola Virus Disease (EVD) screening of passengers at U.S. airports

---

Annual Cost to Federal Government: $11,527,765

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: 10/07/2022

---