United States Traveler Health Declaration

2019 Novel Coronavirus Airport Entry Questionnaires

OMB: 0920-1287

IC ID: 239867

Information Collection (IC) Details

View Information Collection (IC)

United States Traveler Health Declaration 0920-20HF
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-20HF US Traveler health Declaration Web Attachment C COVID-2019 Web Format - U.S. Traveler Health Declaration.3.3.2020.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20HF US Traveler Health Declaration Fillable PDF Attachment D COVID-2019 Fillable PDF - U.S. Traveler Health Declaration.3.3.2020.pdf Yes Yes Fillable Fileable
Form and Instruction 0920-20HF US Traveler Health Declaration Paper Attachment E COVID-2019 Paper - U.S. Traveler Health Declaration_3.2.2020_Final.pdf No   Paper Only
Form and Instruction 0920-1287 U.S. Traveler Health Declaration England/Ireland Paper AttE2_COVID-2019 Paper Format-US Traveler Health Declaration_clean.docx NA No   Paper Only
Form and Instruction 0920-1287 U.S. Traveler Health Declaration England/Ireland Fillable PDF AttD_COVID-2019 Fillable PDF - US Traveler Health Declaration.pdf NA Yes Yes Fillable Fileable
Form and Instruction 0920-1287 US Traveler Health Declaration - Brazil - Paper Format AttE2_COVID-2019 Paper Format-US Traveler Health Declaration_OMB_5.26.2020ChangeRequest-Clean.docx NA No   Paper Only

Health Public Health Monitoring

 

640,000 0
   
Individuals or Households
 
   90 %

  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 640,000 0 -6,155,000 0 0 6,795,000
Annual IC Time Burden (Hours) 160,000 0 -1,538,750 0 0 1,698,750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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