Information Collection Request

Foreign Quarantine Regulations (42CFR71)

ICR 202305-0920-006 · OMB 0920-0134 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0134 can be found here:

Forms and Documents

Document Name	Status
Form 42CFR 71.21(a) Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction	Unchanged
Form 42CFR 71.21(a) Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction	Unchanged
Form 0920-0134 Air Travel Illness or Death Investigation Form Form and Instruction	New
Form 0920-0134 Air Travel Illness or Death Investigation Form Form and Instruction	New
Land Travel Illness or Death Investigation Form Form	Unchanged
Land Travel Illness or Death Investigation Form Form	Unchanged
Form 42 CFR 71.21(a) Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction	Unchanged
Form 42 CFR 71.21(a) Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction	Unchanged
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction	Unchanged
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction	Unchanged
0920-0134 Change Request-5.12.2023.docx Justification for No Material/Nonsubstantive Change	2023-05-12
0920-0134 Change Request-5.12.2023.docx Justification for No Material/Nonsubstantive Change	2023-05-12
Attachment H - IRB Non-Research Determination.pdf Supplementary Document	2022-03-30
Attachment H - IRB Non-Research Determination.pdf Supplementary Document	2022-03-30
Attachment G Privacy Impact Assessment.pdf Supplementary Document	2022-03-30
Attachment G Privacy Impact Assessment.pdf Supplementary Document	2022-03-30
Attachment B - 60 Day FRN - 0920-0134.pdf Supplementary Document	2022-03-30
Attachment B - 60 Day FRN - 0920-0134.pdf Supplementary Document	2022-03-30
0920-0134 Foreign Quarantine Reg SSA3.23.2022_final.docx Supporting Statement A	2022-03-30
0920-0134 Foreign Quarantine Reg SSA3.23.2022_final.docx Supporting Statement A	2022-03-30
0920-0134 Foreign Quarantine Reg SSB3.23.2022.docx Supporting Statement B	2022-03-30
0920-0134 Foreign Quarantine Reg SSB3.23.2022.docx Supporting Statement B	2022-03-30

IC Document Collections

IC ID	Document Title	Status
6646	Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction	Unchanged
6646	Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction	Unchanged
260175	Air Travel Illness or Death Investigation Form Form and Instruction	New
260175	Air Travel Illness or Death Investigation Form Form and Instruction	New
234020	Land Travel Illness or Death Investigation Form Form	Unchanged
234020	Land Travel Illness or Death Investigation Form Form	Unchanged
234019	Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction	Unchanged
234019	Maritime Conveyance Illness or Death Investigation Form (Section 5) Form and Instruction	Unchanged
234012	Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction	Unchanged
234012	Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction	Unchanged
202072	Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft	Modified
189693	42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form))	Unchanged
189692	42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form))	Unchanged

ICR Details

Status	Active
Agency/Subagency	HHS/CDC
OMB Control No	0920-0134
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202203-0920-014
Agency Tracking No	0920-0134
Date Submitted to OIRA	2023-05-12
Requested Expiration Date	1969-12-31