[NCEZID] 2026 Ebola Passenger Disclosure and Attestation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-XXXX EXEMPTION REQUEST (No Form)	Form and Instruction	New	Available
Form 0920-XXXX PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA	Form and Instruction	New	Available
Form 0920-XXXX PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA	Form and Instruction	New	Available
Emergency Review Request Memo - 2026 Ebola Attestation.pdf	Supplementary Document	Uploaded 2026-10-20	Available
Attachment D - Ebola Attestation Non-research Determination.pdf	Supplementary Document	Uploaded 2026-10-20	Available
Attachment A2-42 CFR part 71.pdf	Supplementary Document	Uploaded 2026-10-20	Available
Attachment A1-42 USC 264.pdf	Supplementary Document	Uploaded 2026-10-20	Available
SSB Emergency Clearance_2026 Ebola Passenger Disclosure and Attestation.docx	Supporting Statement B	Uploaded 2026-10-20	Available
SSA Emergency Clearance_2026 Ebola Passenger Disclosure and Attestation.docx	Supporting Statement A	Uploaded 2026-10-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
283164	Traveler - Exemptiion Request Form	Form and Instruction	New	EXEMPTION REQUEST (No Form)
283163	Airline Staff - CDC Ebola Attestation	Form and Instruction	New	PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA
283162	Traveler - CDC Ebola Attestation	Form and Instruction	New	PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA

ICR Details

OMB Control No:	ICR Reference No: 202608-0920-009
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-27-XXXX
Title: [NCEZID] 2026 Ebola Passenger Disclosure and Attestation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 10/21/2026
Date Submitted to OIRA: 10/20/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	6 Months From Approved
Responses	270,600,100	0
Time Burden (Hours)	22,550,200	0
Cost Burden (Dollars)	0	0

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Abstract: NCEZID requests Emergency approval for Attestation Form to be completed by travelers from DRC (2026) The goal of the information collection is to ensure that, consistent with the terms of a pending 2026 Order, passengers arriving in the United States from any foreign country will confirm that they have not been in the Democratic Republic of the Congo in the past 21 days. Airlines will collect signed attestations from all passengers via paper or digital forms.

Emergency Justfication: Emergency Request to prevent spread of Ebola (2026) from DRC. The best strategy to control the spread of the virus to the United States is to stop it at the source with core public health interventions, including case finding, contact tracing, and exit screening of travelers. As part of a layered intervention strategy, the U.S. government is requiring travelers to complete an attestation confirming they have not been present in the Democratic Republic of the Congo (DRC) in the past 21 days before arrival in the United States.

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Authorizing Statute(s): US Code: 42 USC 264 Name of Law: U.S. PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Airline Staff - CDC Ebola Attestation	0920-XXXX	PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA
Traveler - CDC Ebola Attestation	0920-XXXX	PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA
Traveler - Exemptiion Request Form	0920-XXXX	EXEMPTION REQUEST (No Form)

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	270,600,100	0	0	270,600,100	0	0
Annual Time Burden (Hours)	22,550,200	0	0	22,550,200	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Submission is a New Emergency ICR for 2026 Ebola Passenger Disclosure and Attestation

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Annual Cost to Federal Government: $283,962

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/20/2026

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