OMB control number

[NCEZID] Land Travel-related Public Health Activities

OMB 0920-0134 · HHS/CDC.

OMB 0920-0134

The goal of this information collection is to facilitate a CDC public health mission as provided under the Public Health Service Act and Code of Federal Regulations. This Non-Substantive Change Request adds the Air Travel Illness or Death Investigation Form that was previously approved under OMB Control No. 0920-1318 and results in an overall reduction in burden due to a reduction in the number of illness or deaths reported.

The latest form for [NCEZID] Land Travel-related Public Health Activities expires 2026-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4) Form and Instruction
Report by the Master of a Vessel or Person in Charge of Conveyance of the Incidence of a Communicable Disease Occurring While in Interstate Travel Other-OMB Header and Burden Statement
TB Land Contact Investigation Outcome Reporting Form Form and Instruction
General Land Contact Investigation Outcome Reporting Form Form and Instruction
Domestic Land Conveyance Manifest Order Template Instruction
International Land Conveyance Manifest Order Template Instruction
Land Passenger Locator Form Form and Instruction
Air Travel Illness or Death Investigation Form Form and Instruction
Land Travel Illness or Death Investigation Form Form and Instruction
Maritime Conveyance Illness or Death Investigation Form (Section 5) Form
Cumulative Influenza/Influenza-Like Illness (ILI) Form Form and Instruction
Att I_42CFR71.21(b)_Death/Illness Reports from Aircraft
42CFR71.35_Report of Dealth Illness During Stay in Port ((verbal, no form))
42CFR71.33(c) Report by Persons in Isolation or Surveillance ((no form))

All Historical Document Collections

202603-0920-008	Revision of a currently approved collection	2026-03-19
202412-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-12-17
202305-0920-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-05-12
202203-0920-014 Approved without change	Revision of a currently approved collection	2022-03-31
202111-0920-018 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-11-18
202111-0920-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-11-03
202107-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2021-07-23
202009-0920-024 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-10-05
202007-0920-016 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-07-24
202004-0920-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-14
202004-0920-003 Approved with change	No material or nonsubstantive change to a currently approved collection	2020-04-07
201904-0920-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-04-26
201811-0920-003 Approved with change	Revision of a currently approved collection	2018-11-27
201611-0920-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-11-16
201608-0920-009 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-08-16
201509-0920-005 Approved with change	Revision of a currently approved collection	2015-11-17
201502-0920-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2015-02-18
201406-0920-014 Approved with change	Revision of a currently approved collection	2014-07-02
201305-0920-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2013-05-08
201304-0920-018 Approved with change	No material or nonsubstantive change to a currently approved collection	2013-04-29
201304-0920-012 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2013-04-19
201208-0920-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-08-02
201207-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-07-27
201204-0920-005 Approved with change	Revision of a currently approved collection	2012-04-25
201110-0920-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-10-04
200906-0920-019 Approved without change	Extension without change of a currently approved collection	2009-06-24
200509-0920-010 Approved with change	Revision of a currently approved collection	2005-09-23
200110-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2001-10-22
200107-0920-003 Approved without change	Extension without change of a currently approved collection	2001-07-23
199803-0920-003 Approved without change	Reinstatement with change of a previously approved collection	1998-03-26
199405-0920-002 Approved without change	Revision of a currently approved collection	1994-05-20
199105-0920-001 Approved without change	Reinstatement with change of a previously approved collection	1991-05-13
199102-0920-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1991-02-04
198903-0920-002 Approved without change	Extension without change of a currently approved collection	1989-03-09
198812-0920-001 Approved without change	Reinstatement with change of a previously approved collection	1988-12-07
198604-0920-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1986-04-07
198509-0920-002 Approved without change	Revision of a currently approved collection	1985-09-30
198501-0920-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1985-01-25
198308-0920-003 Approved without change	New collection (Request for a new OMB Control Number)	1983-08-10

OMB Details

Att H_42CFR71.21(a )_ Maritime Conveyance Illness or Death Investigation Form (Sections 1-4)

Federal Enterprise Architecture: Health - Immunization Management

Form 42CFR 71.21(a)

Maritime Conveyance illness or Death Investigation Form

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.