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Attachment A: Combined passenger disclosure and attestation to the United States of America

Multi-Language Public Domain

  • 04/4/2022

File Language:


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  • Description:
    OMB Control No.: 0920-1318

    Expiration date: 6/30/2022

    This combined passenger disclosure and attestation fulfills the requirements of U.S. Centers for Disease Control and Prevention (CDC) Amended Orders: Requirements for Negative Pre-Departure COVID-19 Test Result or Documentation of Recovery from COVID-19 for All Airline or Other Aircraft Passengers Arriving into the United States from Any Foreign Country and Implementing Presidential Proclamation on Advancing the Safe Resumption of Global Travel During the COVID-19 Pandemic. As directed by the CDC and the Transportation Security Administration (TSA), through Security Directive 1544-21-03 and Emergency Amendment 1546-21-02, and consistent with CDC’s Order implementing the Proclamation, all airline or other aircraft operators must provide the following disclosures to all passengers prior to their boarding a flight from a foreign country to the United States.

    CS330560-A 04/4/2022

    NCEZID-combined-disclosure-attestation-en-508.pdf

  • Subjects:
  • Document Type:
    Pamphlet (or booklet)
  • Genre:
    Forms
  • Pages in Document:
    5 numbered pages
  • Collection(s):
  • Main Document Checksum:
    urn:sha256:259665ee48f5452f3cc0d70880c152b5a8a734294d11178ab0b3d6a242bd97a1
  • Download URL:
  • File Type:
    Filetype[PDF - 229.37 KB ]
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