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United States Traveler Health Declaration
2019 Novel Coronavirus Airport Entry Questionnaires
OMB: 0920-1287
IC ID: 239867
OMB.report
HHS/CDC
OMB 0920-1287
ICR 202005-0920-013
IC 239867
( )
Documents and Forms
Document Name
Document Type
Form 0920-20HF
United States Traveler Health Declaration
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
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
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
Form and Instruction
0920-1287 U.S. Traveler Health Declaration England/Ireland Paper
AttE2_COVID-2019 Paper Format-US Traveler Health Declaration_clean.docx
Form and Instruction
0920-1287 U.S. Traveler Health Declaration England/Ireland Fillabl
AttD_COVID-2019 Fillable PDF - US Traveler Health Declaration.pdf
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
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
United States Traveler Health Declaration
Agency IC Tracking Number:
0920-20HF
Is this a Common Form?
No
IC Status:
Modified
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
0920-20HF
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
640,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
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.