EVD Initial Screening Questions

2022 Ebola Airport Entry Questionnaires

Documents and Forms

Document Name Document Type
EVD Initial Screening Questions Form and Instruction
INITIAL EBOLA SCREENING SCRIPT 0920-1375 Change Request-2022 Ebola Airport Entry Questionnaires_10.14.2022_final.docx Form and Instruction
INITIAL EBOLA SCREENING SCRIPT 0920-1375 Change Request-2022 Ebola Airport Entry Questionnaires_10.14.2022_final.docx Form and Instruction
Attachment G - Screening Script and SOP_clean_for OMB_10.14.2022_final.docx Screening Script and SOP IC Document
Attachment G - Screening Script and SOP_clean_for OMB_10.14.2022_final.docx Screening Script and SOP IC Document

Information Collection (IC) Details

IC Title:	EVD Initial Screening Questions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	INITIAL EBOLA SCREENING SCRIPT	0920-1375 Change Request-2022 Ebola Airport Entry Questionnaires_10.14.2022_final.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0171 - Quarantine- and Traveler-Related Activities	FR Citation: 83 FR 6591

Number of Respondents: 53,655	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	53,655	53,655
Annual IC Time Burden (Hours)	4,471	4,471
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Screening Script and SOP	Attachment G - Screening Script and SOP_clean_for OMB_10.14.2022_final.docx	10/19/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.