Information Collection

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

IC 245476 under ICR 202105-0920-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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 - Airline Desk Agent	Form and Instruction
PASSENGER DISCLOSURE AND ATTESTATION Attachment D1 - GLOBAL - Passenger disclosure and attestation Attachment A to Order.pdf	Form and Instruction
PASSENGER DISCLOSURE AND ATTESTATION Attachment D1 - GLOBAL - Passenger disclosure and attestation Attachment A to Order.pdf	Form and Instruction
Attachment D5 Fillable PDF Passenger disclosure and attestation Arabic.pdf PASSENGER DISCLOSURE AND ATTESTATION - Arabic	IC Document
Attachment D5 Fillable PDF Passenger disclosure and attestation Arabic.pdf PASSENGER DISCLOSURE AND ATTESTATION - Arabic	IC Document
Attachment D4 Fillable PDF Passenger disclosure and attestation Simplified Chinese.pdf PASSENGER DISCLOSURE AND ATTESTATION - Chinese	IC Document
Attachment D4 Fillable PDF Passenger disclosure and attestation Simplified Chinese.pdf PASSENGER DISCLOSURE AND ATTESTATION - Chinese	IC Document
Attachment D6 Fillable PDF Passenger disclosure and attestation French.pdf PASSENGER DISCLOSURE AND ATTESTATION - French	IC Document
Attachment D6 Fillable PDF Passenger disclosure and attestation French.pdf PASSENGER DISCLOSURE AND ATTESTATION - French	IC Document
Attachment D3 -Fillable PDF Passenger disclosure and attestation Russian.pdf PASSENGER DISCLOSURE AND ATTESTATION - Russian	IC Document
Attachment D3 -Fillable PDF Passenger disclosure and attestation Russian.pdf PASSENGER DISCLOSURE AND ATTESTATION - Russian	IC Document
Attachment D2 -Fillable PDF Passenger disclosure and attestation English.pdf Passenger Disclosure and Attestation - English	IC Document
Attachment D2 -Fillable PDF Passenger disclosure and attestation English.pdf Passenger Disclosure and Attestation - English	IC Document
Attachment D7 Fillable PDF Passenger disclosure and attestation Spanish.pdf Passenger Disclosure and Attestation - Spanish	IC Document
Attachment D7 Fillable PDF Passenger disclosure and attestation Spanish.pdf Passenger Disclosure and Attestation - Spanish	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 - Airline Desk Agent

Agency IC Tracking Number:

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	NA	PASSENGER DISCLOSURE AND ATTESTATION	Attachment D1 - GLOBAL - Passenger disclosure and attestation Attachment A to Order.pdf	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 95,000,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	95,000,000	61,000,000	34,000,000
Annual IC Time Burden (Hours)	7,916,667	5,083,334	2,833,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PASSENGER DISCLOSURE AND ATTESTATION - Arabic	Attachment D5 Fillable PDF Passenger disclosure and attestation Arabic.pdf	05/26/2021
PASSENGER DISCLOSURE AND ATTESTATION - Chinese	Attachment D4 Fillable PDF Passenger disclosure and attestation Simplified Chinese.pdf	05/26/2021
PASSENGER DISCLOSURE AND ATTESTATION - French	Attachment D6 Fillable PDF Passenger disclosure and attestation French.pdf	05/26/2021
PASSENGER DISCLOSURE AND ATTESTATION - Russian	Attachment D3 -Fillable PDF Passenger disclosure and attestation Russian.pdf	05/26/2021
Passenger Disclosure and Attestation - English	Attachment D2 -Fillable PDF Passenger disclosure and attestation English.pdf	05/26/2021
Passenger Disclosure and Attestation - Spanish	Attachment D7 Fillable PDF Passenger disclosure and attestation Spanish.pdf	05/26/2021

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