Combined passenger disclosure and attestation to the united states of america


Participant in certain COVID-19 vaccine trials as determined by CDC



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CDC Attestation

Participant in certain COVID-19 vaccine trials as determined by CDC 
I attest that I am 
excepted
from the requirement to present 
Proof of Being Fully Vaccinated Against COVID-19
and have made the following arrangements (
must check all boxes in D and then proceed to sign Attestation
).
To be tested with a COVID-19 viral test 3-5 days after arriving in the United States, unless I have
documentation of having recovered from COVID-19 in the past 90 days;
To self-isolate if the result of the post-arrival viral test is positive or if I develop COVID-19 symptoms.
On behalf of
, I attest that such person is 
excepted
from the requirement to present 

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