Passenger (airport check-in or gate agent) "Acknowledgement" and collection of information from passengers

Requirement for Airlines and Operators to Collect and Transmit Designated Information for Passengers and Crew Arriving Into the United States

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1354 can be found here:

Documents and Forms

Document Name Document Type
Passenger (airport check-in or gate agent) "Acknowledgement" and collection of information from passengers Form
Passenger “Acknowledgement” and collection of informatio Attachment 4 Passenger “Acknowledgement” and collection of information from passengers.docx Form

Information Collection (IC) Details

IC Title:	Passenger (airport check-in or gate agent) "Acknowledgement" and collection of information from passengers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	NA	Passenger “Acknowledgement” and collection of information from passengers	Attachment 4 Passenger “Acknowledgement” and collection of information from passengers.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0171 Quarantine- or Traveler-related Activities	FR Citation: 83 FR 6591

Number of Respondents: 6,150,000	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
Annual Number of Responses for this IC	6,150,000	6,150,000
Annual IC Time Burden (Hours)	205,000	205,000
Annual IC Cost Burden (Dollars)	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.