United States Traveler Health Declaration

2019 Novel Coronavirus Airport Entry Questionnaires

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1287 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-20HF United States Traveler Health Declaration Form and Instruction
0920-20HF US Traveler health Declaration Web Attachment C COVID-2019 Web Format - U.S. Traveler Health Declaration.3.3.2020.pdf Form and Instruction
0920-20HF US Traveler Health Declaration Fillable PDF Attachment D COVID-2019 Fillable PDF - U.S. Traveler Health Declaration.3.3.2020.pdf Form and Instruction
0920-20HF US Traveler Health Declaration Paper Attachment E COVID-2019 Paper - U.S. Traveler Health Declaration_3.2.2020_Final.pdf Form and Instruction
0920-1287 U.S. Traveler Health Declaration England/Ireland Paper AttE2_COVID-2019 Paper Format-US Traveler Health Declaration_clean.docx Form and Instruction
0920-1287 U.S. Traveler Health Declaration England/Ireland Fillabl AttD_COVID-2019 Fillable PDF - US Traveler Health Declaration.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	United States Traveler Health Declaration	Agency IC Tracking Number:	0920-20HF

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	0920-20HF	US Traveler health Declaration Web	Attachment C COVID-2019 Web Format - U.S. Traveler Health Declaration.3.3.2020.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-20HF	US Traveler Health Declaration Fillable PDF	Attachment D COVID-2019 Fillable PDF - U.S. Traveler Health Declaration.3.3.2020.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-20HF	US Traveler Health Declaration Paper	Attachment E COVID-2019 Paper - U.S. Traveler Health Declaration_3.2.2020_Final.pdf		No		Paper Only
Form and Instruction	0920-1287	U.S. Traveler Health Declaration England/Ireland Paper	AttE2_COVID-2019 Paper Format-US Traveler Health Declaration_clean.docx	NA	No		Paper Only
Form and Instruction	0920-1287	U.S. Traveler Health Declaration England/Ireland Fillable PDF	AttD_COVID-2019 Fillable PDF - US Traveler Health Declaration.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,795,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,795,000	6,495,000	300,000
Annual IC Time Burden (Hours)	1,698,750	1,623,750	75,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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