Request Exemption on Urgent Humanitarian Basis - Traveler

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

⚠️ Notice: This information collection may be referencing outdated material.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
Request Exemption on Urgent Humanitarian Basis - Traveler Form and Instruction
Request Exemption on Urgent Humanitarian Basis Attachment E Information for Humanitarian Exemption Request Considerations-5.4.2021_final.docx Form and Instruction
Request Exemption on Urgent Humanitarian Basis Attachment E Information for Humanitarian Exemption Request Considerations-5.4.2021_final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Request Exemption on Urgent Humanitarian Basis - Traveler	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	Request Exemption on Urgent Humanitarian Basis	Attachment E Information for Humanitarian Exemption Request Considerations-5.4.2021_final.docx	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: 1,300	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	Previously Approved
Annual Number of Responses for this IC	1,300	-3,900	5,200
Annual IC Time Burden (Hours)	2,600	-7,800	10,400
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.