Information Collection

United States Traveler Health Declaration

IC 239867 under ICR 202005-0920-013 · OMB 0920-1287.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-20HF

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.