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

REQUIREMENT FOR NEGATIVE PRE-DEPARTURE COVID-19 TEST RESULT OR DOCUMENTATION OF RECOVERY AND REQUIREMENT FOR PROOF OF COVID-19 VACCINATION FOR NONCITIZEN, NONIMMIGRANT AIR PASSENGERS

⚠️ Notice: This information collection may be referencing outdated material.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 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 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 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 D7 Fillable PDF Passenger disclosure and attestation Spanish.pdf Passenger Disclosure and Attestation - Spanish IC Document

Information Collection (IC) Details

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: Removed

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

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-95,000,000	95,000,000
Annual IC Time Burden (Hours)	-190,000,000	190,000,000
Annual IC Cost Burden (Dollars)	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.