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

REQUIREMENT FOR NEGATIVE PRE-DEPARTURE COVID-19 TEST RESULT OR DOCUMENTATION OF RECOVERY FROM COVID-19 FOR ALL AIRLINE OR AIRCRAFT PASSENGERS ARRIVING INTO THE UNITED STATES FROM ANY FOREIGN COUNTRY

OMB: 0920-1318

IC ID: 245476

⚠️ Notice: This information collection may be referencing outdated material.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 - 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:

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 %

	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

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.