Information Collection

Attestation of a negative COVID-19 test/Documentation indicating clearance for travel by a licensed healthcare provider or public health official - Traveler

IC 245473 under ICR 202101-0920-018 · OMB 0920-1318.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1318 can be found here:

Documents and Forms

Document Name Document Type
Attestation of a negative COVID-19 test/Documentation indicating clearance for travel by a licensed healthcare provider or public health official - Traveler Form and Instruction
PASSENGER DISCLOSURE AND ATTESTATION Attachment C- GLOBAL - Passenger disclosure and attestation.pdf Form and Instruction
Attachment C4 Passenger disclosure and attestation Arabic.pdf PASSENGER DISCLOSURE AND ATTESTATION - Arabic IC Document
Attachment C3 Passenger disclosure and attestation Chinese.pdf PASSENGER DISCLOSURE AND ATTESTATION - Chinese IC Document
Attachment C5 Passenger disclosure and attestation French.pdf PASSENGER DISCLOSURE AND ATTESTATION - French IC Document
Attachment C2 -Passenger disclosure and attestation Russian.pdf PASSENGER DISCLOSURE AND ATTESTATION - Russian IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attestation of a negative COVID-19 test/Documentation indicating clearance for travel by a licensed healthcare provider or public health official - Traveler	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	NA	PASSENGER DISCLOSURE AND ATTESTATION	Attachment C- GLOBAL - Passenger disclosure and attestation.pdf	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0171 - Quarantine-and-Traveler-Related Activities, Including Records for Contact Tracing	FR Citation: 83 FR 6591

Number of Respondents: 34,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34,000,000	34,000,000
Annual IC Time Burden (Hours)	68,000,000	68,000,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PASSENGER DISCLOSURE AND ATTESTATION - Arabic	Attachment C4 Passenger disclosure and attestation Arabic.pdf	01/28/2021
PASSENGER DISCLOSURE AND ATTESTATION - Chinese	Attachment C3 Passenger disclosure and attestation Chinese.pdf	01/28/2021
PASSENGER DISCLOSURE AND ATTESTATION - French	Attachment C5 Passenger disclosure and attestation French.pdf	01/28/2021
PASSENGER DISCLOSURE AND ATTESTATION - Russian	Attachment C2 -Passenger disclosure and attestation Russian.pdf	01/28/2021

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