United States Traveler Health Declaration

2019 Novel Coronavirus Airport Entry Questionnaires

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
0920-1287 US Traveler Health Declaration - Brazil - Paper Format AttE2_COVID-2019 Paper Format-US Traveler Health Declaration_OMB_5.26.2020ChangeRequest-Clean.docx 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
Form and Instruction	0920-1287	US Traveler Health Declaration - Brazil - Paper Format	AttE2_COVID-2019 Paper Format-US Traveler Health Declaration_OMB_5.26.2020ChangeRequest-Clean.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 640,000	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	640,000	-6,155,000	6,795,000
Annual IC Time Burden (Hours)	160,000	-1,538,750	1,698,750
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.