HHS Attachment A Combined Passenger Disclosure and Attestation to the United States of America free printable template
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ATTACHMENT A PASSENGER DISCLOSURE AND ATTESTATION TO THE UNITED STATES OF AMERICA All airlines covered by the Order must provide the following disclosure to passengers and collect the attestation prior to embarkation. AIRLINE DISCLOSURE REQUIREMENT As required by United States federal law all airlines are required to confirm a negative COVID19 test result and collect a passenger attestation on behalf of the U.S. Centers for Disease Control and Prevention CDC for certain passengers on aircraft...
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How to fill out passenger attestation form
How to fill out CDC attestation form:
01
Make sure you have all the necessary information and documents, such as your personal information, travel history, and any potential exposure to COVID-19.
02
Begin by providing your full name, date of birth, and contact information in the designated sections of the form.
03
Specify your current health status, including any symptoms you may be experiencing or if you have tested positive for COVID-19.
04
Declare your travel history in the past 14 days, including the countries or regions you have visited.
05
Indicate if you have been in close contact with someone diagnosed with COVID-19 or if you have been part of a high-risk gathering.
06
Answer additional questions regarding your exposure to COVID-19, such as whether you have been in crowded areas or healthcare settings.
07
Review and double-check all the information you have provided before submitting the form.
Who needs CDC attestation form:
01
Individuals who are traveling internationally may need to fill out the CDC attestation form as part of the required health protocols.
02
Employers or organizations that require employees or participants to undergo health screening before attending an event or returning to work might use the CDC attestation form.
03
Healthcare facilities and professionals may use the CDC attestation form to monitor and assess the health status of patients, visitors, or staff members.
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What is cdc attestation form?
The CDC Attestation Form is a document that employers must complete to certify that their business is taking steps to implement safety measures as outlined in the Centers for Disease Control and Prevention (CDC) Interim Guidance for Businesses and Employers to Plan and Respond to Coronavirus Disease 2019 (COVID-19). The form is intended to help employers communicate their commitment to safety and compliance with CDC guidelines to their employees, customers, and the public.
Who is required to file cdc attestation form?
The CDC Attestation Form is required to be completed by any individual who is seeking to travel to the United States under the Visa Waiver Program (VWP). VWP travelers must complete the form and submit it to the Department of Homeland Security (DHS) prior to their departure for the United States.
How to fill out cdc attestation form?
1. Read the form carefully and make sure you understand the requirements.
2. Enter your name, address, phone number, and email address.
3. On the form, select the appropriate option to indicate whether you are an individual or a business.
4. Select the appropriate option to indicate whether the product is being shipped domestically or internationally.
5. Enter the quantity of the product, the total weight, and the total value of the shipment.
6. Check the “I agree” box to indicate that you agree to the terms and conditions of the form.
7. Sign and date the form.
8. Submit the form to the appropriate agency.
What is the purpose of cdc attestation form?
The purpose of the CDC Attestation Form is to provide the CDC with information, such as the name and contact information of an individual or organization that is requesting access to materials or data related to the CDC's public health programs. The information provided is used to verify the individual or organization's identity and intent to use the materials or data for public health purposes.
What information must be reported on cdc attestation form?
The CDC attestation form requires contact information and detailed information about the traveler, including the traveler's name, address, date of birth, contact information, travel itinerary, and the purpose of the trip. It also requires the traveler to attest that they have read and understand the CDC’s travel guidance, are not exhibiting any symptoms of COVID-19, and will follow all applicable public health guidelines during their trip.
When is the deadline to file cdc attestation form in 2023?
The deadline to file the CDC attestation form in 2023 has not yet been announced.
What is the penalty for the late filing of cdc attestation form?
The penalty for the late filing of a CDC attestation form will vary depending on the specific regulations of the country in question. Generally, late filing may result in a fine, or other sanctions such as the refusal of future applications.
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