Combined passenger disclosure and attestation to the united states of america


Proof of Being Fully Vaccinated Against COVID-19



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CDC Attestation

Proof of Being Fully Vaccinated Against COVID-19
and has made or has had the 
following arrangements made on their behalf (
must check all boxes in G 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 this person has 
documentation of having recovered from COVID-19 in the past 90 days;
To self-quarantine for a full 7 calendar days, even if the test result to this person’s post-arrival viral test is 
negative, except during periods when this person’s attendance is required to carry out the purposes of 
the travel for the U.S. national interest (e.g., to attend official meetings or events), unless this person has 
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 this person develops COVID-19 symptoms.
To become fully vaccinated against COVID-19 within 60 days of arriving in the United States, or as soon 
thereafter as is medically appropriate, if intending to stay in the United States for more than 60 days.

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