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Air Passenger - Section 1 of Combined Passenger Disclosure and Attestation to the United States of America
REQUIREMENT FOR PROOF OF COVID-19 VACCINATION FOR NONCITIZEN, NONIMMIGRANT AIR PASSENGERS
OMB: 0920-1318
IC ID: 250014
OMB.report
HHS/CDC
OMB 0920-1318
ICR 202206-0920-008
IC 250014
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1318 can be found here:
2022-12-27 - Revision of a currently approved collection
2022-12-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-1318
Air Passenger - Section 1 of Combined Passenger Disclosure and Attestation to the United States of America
Form and Instruction
0920-1318 COMBINED PASSENGER DISCLOSURE AND ATTESTATION TO THE UNI
Attachment C-Combined-Passenger-Attestation-10.30.2021.pdf
Form and Instruction
0920-1318 COMBINED PASSENGER DISCLOSURE AND ATTESTATION TO THE UNI
Attachment A - Combined Passenger Attestation for Amended Testing Order-12.2.2021-Clean_.pdf
Form and Instruction
0920-1318 COMBINED PASSENGER DISCLOSURE AND ATTESTATION TO THE UNI
Attachment A - CDC_Clean_Passenger Attestation_FINAL.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Air Passenger - Section 1 of Combined Passenger Disclosure and Attestation to the United States of America
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
0920-1318
COMBINED PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA
Attachment C-Combined-Passenger-Attestation-10.30.2021.pdf
na
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1318
COMBINED PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA 03DEC2021
Attachment A - Combined Passenger Attestation for Amended Testing Order-12.2.2021-Clean_.pdf
NA
Yes
Yes
Fillable Fileable
Form and Instruction
0920-1318
COMBINED PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA 29MAR2022
Attachment A - CDC_Clean_Passenger Attestation_FINAL.pdf
NA
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
09-20-0171 Quarantine- and Traveler-related Activities
FR Citation:
83 FR 6591
Number of Respondents:
123,000,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
0
0
-123,000,000
0
0
123,000,000
Annual IC Time Burden (Hours)
0
0
-246,000,000
0
0
246,000,000
Annual IC Cost Burden (Dollars)
0
0
0
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.