PLF Instructions

PLFInstructions_9-28-2011_OMB.docx

Foreign Quarantine Regulations

PLF Instructions

OMB: 0920-0134

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Instructions for Public Health Passenger Locator Form (English)

Your information is intended to be held in accordance with privacy laws and used only for public health purposes. Complete one form per family. Please write clearly within the boxes. Print in capital (uppercase) letters. Put only one letter or number per box. Keep boxes blank for spaces between words or between numbers and words. Please fill out completely and accurately.

  • Flight information, Questions 1-4: airline name, flight number, seat number (row and letter where you actually sat during the flight) and
    date of arrival (2-digit day, 2-digit month, 4-digit year; example: 30 09 2011)

  • Personal information, Questions 5-8: Last (family) name, first (given) name, middle initial; check male or female

  • Contact information, Questions 9-13: Telephone numbers where you can be reached during your trip: mobile, business, home, other phone numbers (include country and city codes); and email address (if any)

  • Permanent address, Questions 14-19: (where you live most of the year) house number and street name, apartment number (if any), city, state or province, country, ZIP or postal code

  • Temporary address, Questions 20-26: (If you are a visitor, or if you will be at an address other than your permanent home, use the address where you will be staying. Only list the first address.) If staying at a hotel, please include the name. House or building number and street, apartment number (if any), city, state or province, country, ZIP or postal code

  • Emergency contact, Questions 27-33: (someone who can reach you in the next 30 days) Last (family) name, first (given) name, city, country, email address (if any), mobile and other phone numbers (include country and city codes)

  • Travel companions (family), Question 34: On same flight—Last (family) name, first (given) name, seat and row number, and
    age if younger than 18 years

  • Travel companions (non-family), Question 35: On same flight—Last (family) name, first (given) name; or name of your group, if any
    (business, music, or tour group; sports team or other)


Note: Instructions will be translated into 2 other languages on this same page (3 more translations on back side; total of six). Translations to be done by ICAO

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKaren Marienau
File Modified0000-00-00
File Created2021-01-31

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