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CDC Ebola Passenger Disclosure and Attestation Form

Official CDC passenger disclosure and attestation form for individuals traveling to the United States, confirming no presence in the Democratic Republic of the Congo in the past 21 days.

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Order: Requirement for Attestation for All Airline or Other Aircraft Passengers Arriving in the United States | Port Health | CDC

Summary: This document is the official CDC Passenger Disclosure and Attestation form required for all airline passengers traveling to the United States, confirming they have not been in the Democratic Republic of the Congo (DRC) within the previous 21 days.

This document, titled 'Passenger Disclosure and Attestation to the United States of America' (OMB Control No. 0920-1474), is a mandatory form for all passengers boarding international flights to the U.S. It requires passengers to attest that they have not been physically present in the Democratic Republic of the Congo (DRC) in the 21 days prior to boarding. The form outlines legal requirements for airlines to collect and retain these attestations for 42 days and provides a Privacy Act statement regarding the collection and use of passenger data for public health purposes, including contact tracing.

Document outline

1. Passenger Disclosure and Attestation to the United States of America (OMB Control No. 0920-1474) 2. Passenger Attestation Requirement (21-day DRC travel history) 3. Attestation Options (Self or Authorized Representative) 4. Legal Acknowledgement and Penalties 5. Airline and Aircraft Operator Disclosure Requirement 6. Privacy Act Statement (CDC System of Records No. 09-20-0171)

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7 days: 7,420

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