0920-1335 Attestation by A Cruise Ship Operator In Lieu Of A Simul

Phased Approach to the Resumption of Cruise Ship Passenger Operations

ATTESTATION_in lieu of a simulated voyage_05 18 2021_fillable

Attestation by a Cruise Ship Operator in lieu of a Simulated Voyage

OMB: 0920-1335

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The President and Chief Executive Officer of the operating cruise company, the Chief Ethics and/or
Compliance Officer of the operating cruise company and all parent companies, and the highest-ranking
Medical Officer of the operating cruise company and all parent companies must sign the following
attestation:
ATTESTATION BY A CRUISE SHIP OPERATOR
IN LIEU OF A SIMULATED VOYAGE

In accordance with 18 U.S.C. § 1001, I do hereby certify that the following conditions are true and
correct to the best of my knowledge and belief for _________________________________ [insert
name of cruise ship]:
•

Restricted passenger voyages will only operate with 95% 1 of crew who are fully
vaccinated. 2

•

A clear and specific vaccination plan and timeline to limit cruise ship sailings to
95% of passengers who will be confirmed as fully vaccinated prior to sailing has
been submitted to CDC.

I understand that any false statement made in connection with the submission may subject me to
criminal penalties under 18 U.S.C. § 1001. I further understand that this attestation is being submitted
to the CDC in lieu of __________________________________________ [insert name of cruise ship]
conducting a simulated voyage under the CDC’s Framework for Conditional Sailing Order.

_______________________________________________

________________

Signature Official 1
____________________________________________________
Name and Title

Date

_______________________________________________

________________

Signature Official 2
____________________________________________________
Name and Title

Date

_______________________________________________

________________

Signature Official 3
____________________________________________________
Name and Title

Date

1

This excludes any newly embarking crew in quarantine.
People are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose
series (Pfizer-BioNTech or Moderna), or ≥2 weeks after they have received a single-dose vaccine (Johnson & Johnson
[J&J]/Janssen). This applies to COVID-19 vaccines currently authorized for emergency use by the U.S. Food and Drug
Administration: Pfizer-BioNTech, Moderna, and Johnson & Johnson (J&J)/Janssen COVID-19 vaccines. This can also be
applied to COVID-19 vaccines that have been authorized for emergency use by the World Health Organization (e.g.
AstraZeneca/Oxford).
2

_________________________________

________________

Signature Official 4
____________________________________________________
Name and Title

Date

_______________________________________________

________________

Signature Official 5
____________________________________________________
Name and Title

Date

_______________________________________________

________________

Signature Official 6
____________________________________________________
Name and Title

Date


File Typeapplication/pdf
AuthorWhite, Stefanie B. (CDC/DDID/NCEZID/DGMQ)
File Modified2021-05-18
File Created2021-05-18

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