2019 Novel Coronavirus Airport Entry Questionnaires

OMB 0920-1287

CDC has been tasked with conducting public health assessments at U.S. airports of travelers coming from areas experiencing an outbreak of a novel (new) coronavirus (named “2019-nCoV”) in order to detect ill individuals or individuals at risk of being ill with 2019-nCoV. The goal of this information collection is to 1) accurately assess risk for infection or exposure to 2019-nCoV in travelers coming to the United States from locations experiencing an outbreak of 2019-nCoV, and 2) assist states in facilitating public health follow-up of contacts in the event of a confirmed case on an aircraft. The information will be used to determine if individuals meet risk thresholds for further medical evaluation or public health follow-up according to guidance developed by the CDC, and to assist health departments in facilitating public health follow-up, as appropriate. The Non-Substantive Change Request described here is being submitted to adjust the burden for travelers coming to this country from Brazil, and also reflects changes in burden as a result of a decreased number of travelers coming to the U.S.

The latest form for 2019 Novel Coronavirus Airport Entry Questionnaires expires 2020-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-20HF COVID-2019 Air Traveler Illness and Death Investigation Form Form and Instruction
Form 0920-20HF United States Travel Health Declaration for Repatriation from Ship Form and Instruction
Form 0920-20HF Supplemental 2019 Questionnaire Form and Instruction
Form 0920-20HF COVID-2019 Referral Slip Form and Instruction
Form 0920-20HF Preboarding Health Screen Form and Instruction
Form 0920-20HF United States Travel Health Declaration for Repatriation Form and Instruction
Form 0920-20HF United States Traveler Health Declaration Form and Instruction
0920-1287 Change Request- Airport Entry Screening Questionnaire 26MAY2020-GMTF-DGMQ.docx Justification for No Material/Nonsubstantive Change
0920-1287 Change Request- Airport Entry Screening Questionnaire.docx Justification for No Material/Nonsubstantive Change
Attachment L Wuhan Airport Entry Risk Assessment IRB.pdf Supplementary Document
Attachment A2 42 CFR part 71.docx Supplementary Document
Attachment A1 42 USC 264.pdf Supplementary Document
SSB Emergency Clearance COVID-2019 Entry Risk Assessmentl-3.5.2020-Final-CLEAN.docx Supporting Statement B
SSA Emergency Clearance COVID-2019 Entry Risk Assessment_3.5.2020_Final-CLEAN.docx Supporting Statement A
COVID-2019 Air Traveler Illness and Death Investigation Form Form and Instruction
United States Travel Health Declaration for Repatriation from Ship Form and Instruction
Daily Sympton Check Other-Recorded
Supplemental 2019 Questionnaire Form and Instruction
COVID-2019 Referral Slip Form and Instruction
Preboarding Health Screen Form and Instruction
United States Travel Health Declaration for Repatriation Form and Instruction
United States Traveler Health Declaration Form and Instruction

All Historical Document Collections

202005-0920-013 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-05-26
202003-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-03-16
202001-0920-020 Approved with change	New collection (Request for a new OMB Control Number)	2020-03-09

OMB Details

United States Traveler Health Declaration

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-1287	U.S. Traveler Health Declaration England/Ireland Paper	NA	Form and instruction
Form 0920-20HF	US Traveler Health Declaration Paper	Paper Only	Form and instruction
Form 0920-20HF	US Traveler Health Declaration Fillable PDF	Fillable Fileable	Form and instruction
Form 0920-20HF	US Traveler health Declaration Web	Fillable Fileable	Form and instruction
Form 0920-1287	US Traveler Health Declaration - Brazil - Paper Format	NA	Form and instruction
Form 0920-1287	U.S. Traveler Health Declaration England/Ireland Fillable PDF	NA	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.