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Notice2023-00080

Requirements for Negative Pre-Departure COVID-19 Test Results or Documentation of Recovery From COVID-19 for Aircraft Passengers Traveling to the United States From the People's Republic of China

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Published

January 5, 2023

Effective

January 5, 2023

Issuing agencies

Health and Human Services DepartmentCenters for Disease Control and Prevention

Abstract

The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS), announces an Order requiring negative pre-departure COVID-19 test results or documentation of recovery from COVID-19 for aircraft passengers traveling to the United States from the People's Republic of China or departing from a Designated Airport if the passenger has been in the People's Republic of China within the ten (10) days prior to their departure for the United States.

Full Text

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<title>Federal Register, Volume 88 Issue 3 (Thursday, January 5, 2023)</title>
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[Federal Register Volume 88, Number 3 (Thursday, January 5, 2023)]
[Notices]
[Pages 864-871]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-00080]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

Requirements for Negative Pre-Departure COVID-19 Test Results or
Documentation of Recovery From COVID-19 for Aircraft Passengers
Traveling to the United States From the People's Republic of China

AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).

ACTION: General notice.

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SUMMARY: The Centers for Disease Control and Prevention (CDC), located
within the Department of Health and Human Services (HHS), announces an
Order requiring negative pre-departure COVID-19 test results or
documentation of recovery from COVID-19 for aircraft passengers
traveling to the United States from the People's Republic of China or
departing from a Designated Airport if the passenger has been in the
People's Republic of China within the ten (10) days prior to their
departure for the United States.

DATES: This Order will enter into effect for flights departing at or
after 12:01 a.m. EST on January 5, 2023.

FOR FURTHER INFORMATION CONTACT: Candice Swartwood, Division of Global
Migration and Quarantine, Centers for Disease Control and Prevention,
1600 Clifton Road NE, MS H16-4, Atlanta, GA 30329. Telephone: 404-639-
8897; Email: <a href="/cdn-cgi/l/email-protection#2d494a405c5d4241444e54424b4b444e486d4e494e034a425b">[email&#160;protected]</a>.

SUPPLEMENTARY INFORMATION: This Order requires negative pre-departure
COVID-19 test results or documentation of recovery from COVID-19 for
aircraft passengers traveling to the United States from the People's
Republic of China.
Pursuant to 42 CFR 71.20 and 71.31(b), the Order prohibits the
boarding of passengers 2 years of age or older on an itinerary that
includes the United States 1 2 on:
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\1\ This also includes any flight regardless of whether the
United States is the final destination or an intermediate stop.
\2\ A parent or other authorized individual may present the
required documentation on behalf of a passenger 2-17 years of age.
Children under the age of 2 years of age are not subject to the
requirements of this Order. An authorized individual may act on
behalf of any passenger who is unable to act on their own behalf
(e.g., by reason of age, or physical or mental impairment).
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<bullet> any aircraft departing from the People's Republic of
China, or
<bullet> any aircraft departing from a Designated Airport if the
passenger has been in the People's Republic of China within the ten
(10) days prior to their departure for the United States,

unless the passenger presents paper or digital documentation of one of
the following requirements:
(a) A negative viral test result for SARS-CoV-2 \3\ conducted on a
specimen collected no more than 2 calendar days before the flight's
departure from the People's Republic of China or 2 calendar days before
the flight's departure from a Designated Airport if the passenger has
been in the People's Republic of China within the ten (10) days prior
to their departure for the United States (Qualifying Test)
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\3\ SARS-CoV-2 is the virus that causes COVID-19.

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OR

(b) Documentation of having recovered from COVID-19 in the past 90
days in the form of one of the following (i.e., Documentation of
Recovery):
i. A positive viral test result for SARS-CoV-2 conducted on a
specimen collected more than 10 calendar days but fewer than 91
calendar days before the flight's departure; OR
ii. A positive viral test result for SARS-CoV-2 conducted on a
specimen collected 10 or fewer calendar days before the flight's
departure AND a

[[Page 865]]

signed letter from a licensed healthcare provider or public health
official stating that the passenger's COVID-19 symptoms began more than
10 calendar days before the flight's departure.
Each passenger must retain paper or digital documentation presented
to the airline or other aircraft operator reflecting one of the
following:
(a) A negative result for the Qualifying Test; or
(b) Documentation of Recovery from COVID-19.
Upon request, a passenger, or the passenger's authorized
representative, must also produce such documentation to any U.S.
Government official or a cooperating state or local public health
authority.
This Order constitutes a controlled free pratique to any airline or
other aircraft operator with an aircraft boarding passengers subject to
the requirements of this Order at an airport in the People's Republic
of China or a Designated Airport. Pursuant to this controlled free
pratique, the airline or other aircraft operator must comply with the
conditions outlined in the Order.
A copy of the Order is provided below. A copy of the signed Order
and Passenger Attestation can be found at <a href="https://www.cdc.gov/quarantine/china-proof-negative-test.html">https://www.cdc.gov/quarantine/china-proof-negative-test.html</a>.

Centers for Disease Control and Prevention (CDC)

Department of Health and Human Services (HHS)

Notice and Order Under Section 361 of the Public Health Service Act (42
U.S.C. 264) and 42 Code of Federal Regulations 71.20 & 71.31(b)

Requirements for Negative Pre-Departure COVID-19 Test Result or
Documentation of Recovery From COVID-19 for Aircraft Passengers
Traveling to the United States From the People's Republic of China

Summary

Pursuant to 42 CFR 71.20 and 71.31(b) and as set forth in greater
detail below, this Notice and Order prohibits the boarding of
passengers 2 years of age or older on an itinerary that includes the
United States 4 5 on:
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\4\ This also includes any flight regardless of whether the
United States is the final destination or an intermediate stop.
\5\ A parent or other authorized individual may present the
required documentation on behalf of a passenger 2-17 years of age.
Children under the age of 2 years of age are not subject to the
requirements of this Order. An authorized individual may act on
behalf of any passenger who is unable to act on their own behalf
(e.g., by reason of age, or physical or mental impairment).
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unless the passenger presents paper or digital documentation of one of
the following requirements:

(c) A negative viral test result for SARS-CoV-2 \6\ conducted on a
specimen collected no more than 2 calendar days before the flight's
departure from the People's Republic of China or 2 calendar days before
the flight's departure from a Designated Airport if the passenger has
been in the People's Republic of China within the ten (10) days prior
to their departure for the United States (Qualifying Test)
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\6\ SARS-CoV-2 is the virus that causes COVID-19.

---------------------------------------------------------------------------
OR

(d) Documentation of having recovered from COVID-19 in the past 90
days in the form of one of the following (i.e., Documentation of
Recovery):
iii. A positive viral test result for SARS-CoV-2 conducted on a
specimen collected more than 10 calendar days but fewer than 91
calendar days before the flight's departure; OR
iv. A positive viral test result for SARS-CoV-2 conducted on a
specimen collected 10 or fewer calendar days before the flight's
departure AND a signed letter from a licensed healthcare provider or
public health official stating that the passenger's COVID-19 symptoms
began more than 10 calendar days before the flight's departure.
Each passenger must retain paper or digital documentation presented
to the airline or other aircraft operator reflecting one of the
following:
(c) A negative result for the Qualifying Test; or
(d) Documentation of Recovery from COVID-19.
Upon request, a passenger, or the passenger's authorized
representative, must also produce such documentation to any U.S.
Government official or a cooperating state or local public health
authority.
This Order applies regardless of citizenship or vaccination status.
This Order excludes passengers transiting the People's Republic of
China (for a period of 24 hours or less) en route to the United States.
This Order also excludes passengers who have been in the People's
Republic of China for less than 24 hours.
Pursuant to 42 CFR 71.31(b), and as set forth in greater detail
below, this Notice and Order constitutes a controlled free pratique to
any airline or other aircraft operator with an aircraft boarding
passengers subject to the requirements of this Order at an airport in
the People's Republic of China or a Designated Airport. Pursuant to
this controlled free pratique, the airline or other aircraft operator
must comply with the following conditions to receive permission for the
aircraft to enter and disembark passengers within the United States:
\7\
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\7\ Under 42 CFR 71.31(b), CDC may condition a carrier's arrival
into the United States by issuing a controlled free pratique without
requiring the detention of an arriving carrier. This controlled free
pratique applies to any airlines and aircraft operators operating
aircraft boarding passengers subject to the requirements of this
Order. This controlled free pratique operates in aid of CDC's
authority under 42 CFR 71.20 to conduct public health prevention
measures to detect the potential presence of communicable disease.
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<bullet> Airline or other aircraft operator must confirm that every
passenger subject to the requirements of this Order onboard the
aircraft has presented a negative result for a Qualifying Test or
Documentation of Recovery.
<bullet> Airline or other aircraft operator must verify that every
passenger subject to the requirements of this Order onboard the
aircraft has attested to one of the following:
[cir] Having received a negative result for the Qualifying Test, or
[cir] Having met the criteria for Documentation of Recovery by:
[ssquf] testing positive for SARS-CoV-2 on a specimen collected
more than 10 calendar days but fewer than 91 calendar days before the
flight's departure, or
[ssquf] developing COVID-19 symptoms more than 10 full calendar
days before the flight's departure if their positive test is dated 10
or fewer calendar days before the flight.
This Notice and Order does not alter the obligation of persons to
comply with the applicable requirements of other CDC Orders, including:
<bullet> Amended Order Implementing Presidential Proclamation on
Advancing the Safe Resumption of Global Travel During the COVID-19
Pandemic (published at 86 FR 61224, April 4, 2022); and
<bullet> Other CDC Orders or CDC Directives that may be published
relating to preventing the introduction, transmission, and spread of
COVID-19 into and throughout the United States.
This Order shall enter into effect for flights departing at or
after 12:01 a.m. EST (5:01 a.m. GMT) on January 5, 2023.

[[Page 866]]

Statement of Intent

This Order shall be interpreted and implemented to achieve the
following paramount objectives:
<bullet> Preservation of human life;
<bullet> Preventing or delaying the introduction, transmission, and
spread of any new variants of the virus that causes COVID-19 that may
be circulating or emerge in the People's Republic of China;
<bullet> Preserving the health and safety of crew members,
passengers, airport personnel, and communities; and
<bullet> Preserving hospital, healthcare, and emergency response
resources and capacity within the United States.

Definitions

Aircraft shall have the same definition as under 49 U.S.C.
40102(a)(6). ``Aircraft'' includes, but is not limited to, commercial,
general aviation, and private aircraft.
Aircraft Operator means an individual or organization causing or
authorizing the operation of an aircraft.
Airline shall have the same definition as under 42 CFR 71.1(b).
Attest/Attestation means having completed the attestation in
Attachment A. Such attestation may be completed in paper or digital
form. The attestation is a statement, writing, entry, or other
representation under 18 U.S.C. 1001.\8\
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\8\ CDC encourages airlines and aircraft operators to
incorporate the attestation into paperless check-in processes. An
airline or aircraft operator may use a third party (including a
third-party application) to collect attestations, including to
provide translations. However, an airline or aircraft operator has
sole legal responsibility to provide and collect attestations, to
ensure the accuracy of any translation, and to comply with all other
obligations under this Order. An airline or aircraft operator is
responsible for any failure of a third party to comply with this
Order. An airline or aircraft operator may not shift any legal
responsibility to a third party.
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Designated Airports mean those airports outside of the People's
Republic of China where the requirements of this Order apply.
Designated Airports include Incheon International Airport (ICN) in
Seoul, Republic of Korea; Toronto Pearson International Airport (YYZ)
in Canada; Vancouver International Airport (YVR) in Canada; and other
airports that CDC may list in guidance associated with this Order.\9\
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\9\ In adding new airports, CDC will consider data regarding
travel patterns of passengers departing the People's Republic of
China on itineraries to the United States, as well as additional
information concerning the emergence of virus variants.
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Documentation of Recovery means paper or digital documentation of
having recovered from COVID-19 in the form of a positive SARS-CoV-2
viral test result. The viral test must have been conducted on a
specimen collected more than 10 calendar days but fewer than 91
calendar days before the departure of the flight, or at such other
intervals as specified in CDC guidance. Alternatively, Documentation of
Recovery may consist of a positive SARS-CoV-2 viral test result from a
specimen collected 10 or fewer calendar days before the flight's
departure AND a signed letter from a licensed healthcare provider or
public health official stating that the passenger's symptoms began more
than 10 full calendar days before the flight's departure.
People's Republic of China for the purpose of this Notice and Order
means the People's Republic of China, including the Special
Administrative Regions of Hong Kong and Macau.
Qualifying Test means a SARS-CoV-2 viral test that was conducted on
a specimen collected no more than two (2) calendar days before the
passenger's departure from the People's Republic of China, or a
Designated Airport if the passenger has been in the People's Republic
of China within the ten (10) days prior to departure for the United
States.
United States has the same definition as ``United States'' in 42
CFR 71.1(b), meaning ``the 50 States, District of Columbia, and the
territories (also known as possessions) of the United States, including
American Samoa, Guam, the Northern Mariana Islands, the Commonwealth of
Puerto Rico, and the U.S. Virgin Islands.''
Viral Test means a viral detection test for current infection with
SARS-CoV-2, i.e., a nucleic acid amplification test (NAAT) or a viral
antigen test. The test must be cleared, approved, or issued an
emergency use authorization by the U.S. Food and Drug Administration,
or granted marketing authorization by the relevant national authority,
for the detection of SARS-CoV-2.

Exceptions

The following categories of individuals and organizations are
excepted from the requirements of this Order:
<bullet> Crew members of airlines or other aircraft operators if
they are on official duty assigned by the airline or aircraft operator
that involves operation of the aircraft or positioning of crew not
operating the aircraft, provided their assignment is under an air
carrier's or operator's occupational health and safety program that
follows applicable industry standard protocols for the prevention of
COVID-19 consistent with relevant CDC guidance.
<bullet> Airlines or other aircraft operators transporting
passengers with COVID-19 on flights other than scheduled passenger
airline flights pursuant to CDC authorization \10\ and with infection
control measures in place to prevent onboard transmission consistent
with relevant CDC guidance.
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\10\ Federal regulations at 42 CFR 71.21(b) requires the
commander of an aircraft destined for a U.S. airport to report
immediately to the quarantine station at or nearest the airport at
which the aircraft will arrive, the occurrence, on board, of any
death or ill person among passengers or crew.
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<bullet> U.S. Federal law enforcement personnel on official orders
who are traveling for the purpose of carrying out a law enforcement
function, provided they are covered under an occupational health and
safety program that takes measures to ensure personnel are not
symptomatic or otherwise at increased risk of spreading COVID-19 during
travel. Those traveling for training or other business purposes remain
subject to the requirements of this Order.
<bullet> U.S. military personnel, including civilian employees,
dependents, contractors, and other U.S. Government employees when
traveling on U.S. military assets (including whole aircraft charter
operators) or non-U.S. military flights, if such individuals are under
competent military or U.S. Government travel orders and observing
applicable U.S. Department of Defense force health protection guidance
to prevent the transmission of COVID-19.
<bullet> Individuals for whom the issuance of a humanitarian
exception is necessary based on both: (1) exigent circumstances where
emergency travel is required to preserve health and safety (e.g.,
emergency medical evacuations); and (2) where pre-departure testing
cannot be accessed or completed before travel because of exigent
circumstances.

Background

A. COVID-19 in the People's Republic of China and Emergence of Virus
Variants of Concern

COVID-19 is surging in the People's Republic of China.\11\
Mitigation

[[Page 867]]

measures are largely not in use, and there are significant gaps in data
and information on cases, hospitalizations, deaths, and genomic
sequences. The population in the People's Republic of China lacks
extensive exposure to the virus that causes COVID-19 and therefore
lacks substantial immune protection through prior infection. The recent
surge in COVID-19 transmission, particularly in a large population such
as the People's Republic of China, increases the potential for new
SARS-CoV-2 variants to emerge that could be introduced to the United
States.
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\11\ On June 10, 2022, CDC rescinded the Order titled
``Requirement for Negative Pre-Departure COVID-19 Test Result or
Documentation of Recovery from COVID-19 for All Airline or Other
Aircraft Passengers Arriving in the United States from any Foreign
Country.'' As part of its rescission, CDC stated that it would
periodically reassess the need for a testing requirement based on
the latest science, virus variants, and evolving state of the
pandemic, and could reinstitute testing if necessary to protect the
public's health. The current Order is a more targeted application of
the testing requirement to address specifically the lack of
available information in global databases about virus variants
potentially circulating in the People's Republic of China. Although
many of the factors cited in the June 10 rescission that strengthen
community and individual protection against serious illness from
COVID-19, including efficacious and accessible treatments continue
to exist, CDC has concluded that the current Order is needed to
protect the public's health.
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Although virus variants continue to emerge in countries around the
world, the lack of viral genomic sequence data from the People's
Republic of China in global databases could delay the identification of
new virus variants of concern if they arise. These data are critical to
monitor the surge effectively and to allow U.S. public health officials
to identify any potential virus variants of concern.
New virus variants have the potential to evade the immune
protection acquired in the U.S. population through vaccination and
prior illness. The emergence of virus variants that substantially
decrease the effectiveness of available vaccines against severe or
deadly COVID-19, and decrease the effectiveness of therapeutics and
diagnostics, is a primary public health concern for the United States.
Additionally, new virus variants could be associated with increases in
transmissibility (higher infection rates) or severity (higher rates of
hospitalization or death) that have the potential to overwhelm U.S.
healthcare systems, especially at a time when influenza and other
respiratory viruses are circulating.\12\
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\12\ Influenza Hospitalization Surveillance Network (FluSurv-
NET): <a href="https://www.cdc.gov/flu/weekly/influenza-hospitalization-surveillance.htm">https://www.cdc.gov/flu/weekly/influenza-hospitalization-surveillance.htm</a>.
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Considering the danger to public health posed by potential emerging
new virus variants in the People's Republic of China, CDC has
determined that additional proactive, preventative measures must be
implemented now to protect the U.S. population from potential
importation, transmission and spread of new virus variants into the
United States. Pre-departure testing and the requirement to show a
negative test result decrease the number of infected passengers
boarding airplanes and constitute a proactive, risk-based approach.
This will help to slow the spread of COVID-19 as we work to identify
and understand any potential new virus variants that may emerge. This
risk-based testing approach has been addressed in CDC guidance.\13\
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\13\ COVID-19 Testing: What You Need to Know <a href="https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html#when-to-get-tested">https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html#when-to-get-tested</a>.
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CDC acknowledges that pre-departure testing does not eliminate all
risk and some positive COVID-19 cases may evade this detection measure.
Some tests, including antigen tests, may have lower sensitivity for the
virus that causes COVID-19. Some people who test negative within 2 days
before their flight may also be exposed to or develop COVID-19 after
being tested. Therefore, CDC will implement this testing requirement
simultaneously with other mitigation measures, including enhanced
education and surveillance strategies.
CDC is expanding the Traveler-based Genomic Surveillance program
(TGS), a voluntary program that collects anonymous nasal swabs from
arriving international travelers at major U.S. international airports
as an early warning system to detect and characterize new and rare
variants of the virus that causes COVID-19. The program tests for
presence of the virus, and if it is detected, the program sequences the
virus's genome to identify any new variants. The program is expanding
in order to support increased information about potential virus
variants imported from the People's Republic of China.
As part of the Traveler-based Genomic Surveillance program,
arriving international travelers on selected flights can volunteer to
provide anonymous nasal swabs for testing. The nasal swabs get batched
into pools and all positive batches undergo genomic sequencing for the
virus, allowing for the quick detection of virus variants from
international travelers. This program has proven to overcome gaps in
global SARS-CoV-2 variant surveillance that occur as many countries
decrease or discontinue testing and sequencing. During the initial
weeks of the Omicron surge, TGS detected two Omicron subvariants, BA.2
and BA.3, and reported them to the global database weeks before they
were reported elsewhere, demonstrating that the program is able to
detect new virus variants early.
Pre-departure testing and the requirement to show a negative test
reduces the introduction, transmission, and spread into the United
States of virus variants. These measures provide a safer environment
for travelers and protect the health of people in the United States,
particularly when layered with existing CDC recommendations such as
masking during travel, self-monitoring for symptoms, and testing three
to five days after arrival from international travel.

B. Statement of Good Cause Under the Administrative Procedure Act
(``APA'')

The recent surge in COVID-19 cases in the People's Republic of
China may result in the emergence of new virus variants that can
increase transmissibility or severity or compromise the effectiveness
of current medical countermeasures. Because of policies of the People's
Republic of China relating to COVID-19, the population has not
developed immune protection and is more susceptible to infection when
compared with other countries. Travelers are an important population to
consider when tracking new and emerging infectious diseases because
they move from place to place quickly and can contract and spread
infectious diseases. Pre-departure testing and the requirement to show
a negative test helps prevent infected travelers from boarding flights
to the United States and slows the introduction, transmission, and
spread of virus variants into the United States. The introduction of
infected travelers and potential emergence of virus variants of concern
are of particular concern at this time, when the United States'
healthcare system is already facing surges in other respiratory
viruses.
Based on the lack of viral genomic sequence data from the People's
Republic of China, this action is necessary imminently to allow U.S.
public health officials the critical time needed to monitor the
unprecedented surge of COVID-19 in the People's Republic of China
effectively and to identify any potential variants of concern. CDC will
continue to monitor the situation and be prepared to quickly adjust its
approach as necessary to protect the public's health.
Due to the current volume of passengers from the People's Republic
of China transiting through Incheon International Airport, Toronto
Pearson International Airport, and Vancouver International Airport on
their way to the United States, I have determined that prompt action is
needed with respect to travelers departing from these airports if they
have been in the People's Republic of China in the last 10 days. CDC,
in coordination with other Federal agencies, will continue to monitor
travel patterns between the People's Republic of China and the United
States and adjust its approach as needed.

[[Page 868]]

This Order is not a rule within the meaning of the Administrative
Procedure Act (``APA'') but rather is an emergency action taken under
the existing authority of 42 U.S.C. 264(a) and 42 CFR 71.20 and
71.31(b), which were promulgated in accordance with the APA after full
notice-and-comment rulemaking and a delay in effective date. In the
event that this Order qualifies as a new rule under the APA, notice and
comment and a delay in effective date are not required because there is
good cause to dispense with prior public notice and comment and a delay
in effective date. See 5 U.S.C. 553(b)(B), (d)(3).
Considering the rapid surge in cases in the People's Republic of
China, it would be impracticable and contrary to the public's health,
and by extension the public's interest, to delay the issuance and
effective date of this Order. Further delay could increase risk of
transmission and importation of undetected emerging virus variants
through passengers. New virus variants could be associated with
increases in transmissibility (higher case rates), severity (higher
rates of hospitalization or death), and have the potential to overwhelm
U.S. healthcare systems, especially at a time when influenza and other
respiratory viruses are circulating.
Similarly, the Office of Information and Regulatory Affairs has
determined that if this Order were a rule, it would be a major rule
under Subtitle E of the Small Business Regulatory Enforcement Fairness
Act of 1996 (the Congressional Review Act), 5 U.S.C. 804(2), but there
would not be a delay in its effective date as the agency has determined
that there would be good cause to make the requirements herein
effective immediately under the APA, 5 U.S.C. 808(2).
This Order is also an economically significant regulatory action
under Executive Order 12866 and has therefore been reviewed by the
Office of Information and Regulatory Affairs of the Office of
Management and Budget.
Pursuant to 5 U.S.C. 553(b)(B), and for the reasons stated above, I
hereby conclude that good cause exists to dispense with notice-and-
comment rulemaking because engaging in such rulemaking is impractical,
would endanger the public health, and thus, be contrary to the public
interest. For the same reasons, I have determined, consistent with 5
U.S.C. 553(d)(3), that there is good cause to make this Order effective
for flights departing at or after 12:01 a.m. EST (5:01 a.m. GMT) on
January 5, 2023.

C. Severability

If any provision of this Order, or the application of any provision
to any carriers, persons, or circumstances, shall be held invalid, I
intend that the remainder of the provisions, or the application of such
provisions to any carriers, persons, or circumstances other than those
to which it is held invalid, shall remain valid and in effect. Although
the application of all of this Order's provisions uniformly across all
carriers, persons, and circumstances will maximize the Order's
protection of health and safety, the various provisions and
applications of this Order operate independently and independently
further the purposes of this Order. Thus, in the event of a stay or
invalidation of any provision of the Order, or of the Order as it
applies to any carrier, person, or circumstances, my intent is that the
remainder of the Order remain in effect.

Action

For the reasons outlined above, I hereby determine that passengers
subject to the requirements of this Order are at risk of transmitting
new SARS-CoV-2 variants that may be circulating or emerge in the
People's Republic of China. Accordingly, requiring these passengers to
present either a negative COVID-19 test result or recovery from COVID-
19 in the past 90 days is necessary to reduce the risk of introduction,
transmission and spread of new SARS-CoV-2 variants, and to protect the
health of fellow passengers, aircraft crew, and U.S. communities. This
Order shall remain effective until I determine that based on specific
public health or other considerations that continuation of this Order
is no longer necessary to prevent the introduction, transmission, and
spread of new SARS-CoV-2 variants into the United States. Upon
determining that continuation of this Order is no longer necessary to
prevent the introduction, transmission, and spread of new SARS-CoV-2
variants into the United States, I will publish a notice in the Federal
Register terminating this Order. I retain the authority to modify or
terminate the Order, or its implementation, at any time as needed to
protect public health.

1. Requirements for Airlines & Other Aircraft Operators

Any airline or other aircraft operator boarding passengers subject
to the requirements of this Order shall:
A. Identify which passengers are subject to the requirements of
this Order and confirm that each such passenger, prior to boarding the
aircraft, has presented paper or digital documentation reflecting a
Qualifying Test or Documentation of Recovery or meets one of the
specified exceptions.
(1) Requirements for a Qualifying Test include:
a. Documentation of a negative SARS-CoV-2 viral test result from a
specimen collected no more than 2 calendar days before the flight's
departure. The negative SARS-CoV-2 viral test result must include:
i. personal identifiers (e.g., name and date of birth) on the
negative test result that match the personal identifiers on the
passenger's passport or other travel documents;
ii. a specimen collection date indicating that the specimen was
collected no more than 2 calendar days before the flight's departure;
iii. the type of viral test indicating it is a NAAT or antigen
test;
iv. a test result that states ``NEGATIVE,'' ``SARS-CoV-2 RNA NOT
DETECTED,'' ``SARS-CoV-2 ANTIGEN NOT DETECTED,'' or ``COVID-19 NOT
DETECTED,'' or other indication that SARS-CoV-2 was not detected in the
individual's specimen. A test marked ``invalid'' is not acceptable; and
v. information about the entity issuing the result (e.g.,
laboratory, healthcare entity, or telehealth service), such as the name
and contact information.
(2) Requirements for Documentation of Recovery include one of the
following:
a. Documentation of a positive SARS-CoV-2 viral test result from a
specimen collected more than 10 calendar days but fewer than 91
calendar days preceding the flight's departure.\14\ The positive SARS-
CoV-2 viral test result must include:
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\14\ Interim Guidance on Ending Isolation and Precautions for
Adults with COVID-19 <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html">https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html</a>.
---------------------------------------------------------------------------

i. personal identifiers (e.g., name and date of birth) on the
positive test result that match the personal identifiers on the
passenger's passport or other travel documents;
ii. a specimen collection date indicating that the specimen was
collected more than 10 calendar days but fewer than 91 calendar days
before the flight's departure;
iii. information that the test performed was a viral test
indicating it is a NAAT or antigen test;
iv. a test result that states ``POSITIVE,'' ``SARS-CoV-2 RNA
DETECTED,'' ``SARS-CoV-2 ANTIGEN DETECTED,'' or ``COVID-19 DETECTED,''
or other indication that

[[Page 869]]

SARS-CoV-2 was detected in the individual's specimen. A test marked
``invalid'' is not acceptable; and
v. information about the entity issuing the result (e.g.,
laboratory, healthcare entity, or telehealth service), such as the name
and contact information.
b. Documentation of a positive SARS-CoV-2 viral test result from a
specimen collected 10 or fewer calendar days before the flight's
departure AND a signed letter from a licensed healthcare provider or a
public health official stating that the passenger's COVID-19 symptoms
began more than 10 calendar days before the flight's departure. The
letter must list the date the person's symptoms started; have personal
identifiers (e.g., name and date of birth) that match the personal
identifiers on the passenger's passport or other travel documents; and
be signed and dated on official letterhead that contains the name,
address, and phone number of the healthcare provider or public health
official who signed the letter. The positive SARS-CoV-2 viral test
result must include:
i. personal identifiers (e.g., name and date of birth) on the
positive test result that match the personal identifiers on the
passenger's passport or other travel documents;
ii. information that the test performed was a viral test indicating
it is a NAAT or antigen test;
iii. a test result that states ``POSITIVE,'' ``SARS-CoV-2 RNA
DETECTED,'' ``SARS-CoV-2 ANTIGEN DETECTED,'' or ``COVID-19 DETECTED,''
or other indication that SARS-CoV-2 was detected in the individual's
specimen. A test marked ``invalid'' is not acceptable; and
iv. information about the entity issuing the result (e.g.,
laboratory, healthcare entity, or telehealth service), such as the name
and contact information.
B. Confirm that each passenger has attested to having received a
negative result for a Qualifying Test or having met the requirements
for Documentation of Recovery. Airlines or other aircraft operators
must retain a copy of each passenger attestation for 2 years. The
attestation is attached to this order as Attachment A.
C. Not board any passenger without confirming the documentation as
set forth in this Order.
Any airline or other aircraft operator that fails to comply with
section 1, ``Requirements for Airlines & Other Aircraft Operators,''
may be subject to criminal penalties under, inter alia, 42 U.S.C. 271
and 42 CFR 71.2, in conjunction with 18 U.S.C. 3559 and 3571.

2. Requirements for Aircraft Passengers

Any aircraft passenger subject to the requirements of this Order
shall--
A. Present paper or digital documentation reflecting one of the
following:
(1) A negative Qualifying Test that has a specimen collection date
indicating that the specimen was collected no more than 2 calendar days
before the flight's departure; or
(2) Documentation of Recovery from COVID-19 that includes:
a. a positive SARS-CoV-2 viral test result conducted on a specimen
collected more than 10 calendar days but fewer than 91 calendar days
preceding the passenger's scheduled flight to the United States; OR
b. documentation of a positive SARS-CoV-2 viral test result from a
specimen collected 10 or fewer calendar days before the flight's
departure AND a signed letter from a licensed healthcare provider or a
public health official stating that the passenger's COVID-19 symptoms
began more than 10 days before the flight's departure.
B. Provide the attestation to the airline or other aircraft
operator, of:
(1) having received a negative result for the Qualifying Test; or
(2) having met the requirements for Documentation of Recovery.
The attestation is attached to this order as Attachment A. A parent
or other authorized individual may present the required documentation
on behalf of a passenger 2-17 years of age. An authorized individual
may act on behalf of any passenger who is unable to act on their own
behalf (e.g., by reason of age, or physical or mental impairment).
C. Retain a copy of the applicable documentation listed in part A
of this section and produce such documentation upon request to any U.S.
Government official or a cooperating state or local public health
authority after arrival into the United States.
Any passenger who fails to comply with the requirements of section
2, ``Requirements for Aircraft Passengers,'' may be subject to criminal
penalties under, inter alia, 42 U.S.C. 271 and 42 CFR 71.2, in
conjunction with 18 U.S.C. 3559 and 3571. Willfully giving false or
misleading information to the Government may result in criminal
penalties under, inter alia, 18 U.S.C. 1001.
This Order shall be enforceable through the provisions of 18 U.S.C.
3559, 3571; 42 U.S.C. 243, 268, 271; and 42 CFR 71.2. As the COVID-19
pandemic continues to rapidly evolve and more scientific data becomes
available regarding potential emerging virus variants in the People's
Republic of China, CDC may exercise its enforcement discretion to
adjust the scope of accepted pre-departure testing requirements to
allow passengers and airline and aircraft operators greater flexibility
regarding the requirements of this Order or to align with current CDC
guidance. Such exercises of enforcement discretion will be announced on
CDC's website and the Order will be amended as soon as practicable
through an updated publication in the Federal Register.

Effective Date

This Order shall enter into effect for flights departing at or
after 12:01 a.m. EST (5:01 a.m. GMT) on January 5, 2023, and will
remain in effect unless modified or rescinded based on specific public
health or other considerations.

Authority

The authority for this Order is Section 361 of the Public Health
Service Act (42 U.S.C. 264) and 42 CFR 71.20 & 71.31(b).

Dated: January 3, 2023.
Sherri Berger,
Chief of Staff, Centers for Disease Control and Prevention.

Attachment A

Proof of Negative Covid-19 Test Result or Documentation of Recovery for
Air Passengers From the People's Republic of China

Notice to Airlines and Aircraft Operators

This passenger disclosure and attestation fulfills the requirements
of U.S. Centers for Disease Control and Prevention (CDC) Order:
Requirements for Negative Pre-Departure COVID-19 Test Result or
Documentation of Recovery from Covid-19 for All Airline or Other
Aircraft Passengers Traveling to the United States from the People's
Republic of China.15 16
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\15\ This requirement (i.e., proof of negative COVID-19 test or
recovery) does not apply to crewmembers of airlines or other
aircraft operators on official duty assigned by the airline or
aircraft operator that involves operation of the aircraft or
repositioning of crew (i.e., on ``deadhead'' status), provided their
assignment is under an air carrier's or operator's occupational
health and safety program that follows applicable industry standard
protocols for the prevention of COVID-19 consistent with relevant
CDC guidance. See the Order and CDC's website for more information
about applicability and exceptions.
\16\ People's Republic of China includes the Special
Administrative Regions of Hong Kong and Macau.
---------------------------------------------------------------------------

Airline and Aircraft Operator Disclosure Requirements

As required by United States Federal law, all airlines or other
aircraft

[[Page 870]]

operators must collect the passenger attestation on behalf of the U.S.
Government.\17\
---------------------------------------------------------------------------

\17\ This attestation does not need to be completed by or on
behalf of children under 2 years of age. The airline or other
aircraft operator may permit them to board an aircraft without an
attestation.
---------------------------------------------------------------------------

As required by the Order, all airlines and other aircraft operators
must provide this disclosure to all air passengers who are ages 2 years
and older \18\ who have an itinerary that includes the United States
and are boarding:
---------------------------------------------------------------------------

\18\ This Order applies to any passenger 2 years of age or
older, regardless of citizenship or vaccination status.
---------------------------------------------------------------------------

(1) an aircraft in the People's Republic of China, or
(2) an aircraft at a Designated Airport if the passenger has been
in the People's Republic of China in the past 10 calendar days.
Designated Airports include Incheon International Airport (ICN) in
Seoul, Republic of Korea; Toronto Pearson International Airport (YYZ)
in Canada; and Vancouver International Airport (YVR) in Canada.
This requirement does not apply to passengers transiting through an
airport in the People's Republic of China en route from another country
to the United States. It also does not apply to passengers who have
been in the People's Republic of China for less than 24 hours.
The airline must identify which passengers are subject to the
requirements of this Order and confirm that each such passenger, prior
to boarding the aircraft, has presented paper or digital documentation
reflecting:
A. A negative result for a COVID-19 viral test taken no more than 2
days before the departure of the flight from an airport in the People's
Republic of China or a Designated Airport; or
B. Documentation of Recovery from COVID-19 in the form of:
[ssquf] A positive viral test result for COVID-19 conducted on a
sample collected more than 10 calendar days but fewer than 91 calendar
days before the departure of the flight from an airport in the People's
Republic of China or a Designated Airport; or
[ssquf] A positive viral test result for COVID-19 conducted on a
sample taken 10 or fewer calendar days before the flight AND a signed
letter from a licensed healthcare provider or public health official
stating that the passenger's symptoms began more than 10 calendar days
before the departure of the flight from an airport in the People's
Republic of China or a Designated Airport; or
C. A Humanitarian Exception in the form of a letter from the U.S.
Government

OMB Control No.: 0920-XXXX

Proof of Negative Covid-19 Test Result or Documentation of Recovery for
Air Passengers From the People's Republic of China 19
---------------------------------------------------------------------------

\19\ People's Republic of China includes the Special
Administrative Regions of Hong Kong and Macau.
---------------------------------------------------------------------------

Passenger Disclosure and Attestation

The information provided below must be accurate and complete to the
best of the person's knowledge. Under United States Federal law, the
attestation must be completed for each air passenger 2 years of age or
older who has an itinerary that includes the United States and is
boarding an aircraft in the People's Republic of China; or is boarding
an aircraft at a Designated Airport and has been in the People's
Republic of China in the last 10 calendar days. Failure to complete and
present the applicable portion of the attestation, or submitting false
or misleading information, could result in delay of travel, denial of
boarding, or denial of boarding on future travel, or put the passenger
or other people at risk of harm, including serious bodily injury or
death. Any passenger who fails to comply with these requirements may be
subject to criminal penalties. Willfully providing false or misleading
information may lead to criminal fines and imprisonment under, among
other provisions, 18 U.S.C. 1001. Providing this information can help
protect you, your friends and family, your communities, and the United
States. The U.S. Centers for Disease Control and Prevention (CDC)
appreciates your cooperation.
One attestation form must be filled out for each air passenger 2
years of age or older with an itinerary that includes the United States
prior to boarding
(1) an aircraft in the People's Republic of China; or
(2) an aircraft at a Designated Airport if the passenger has been
in the People's Republic of China in the last 10 days. Designated
Airports include Incheon International Airport (ICN) in Seoul, the
Republic of Korea; Toronto Pearson International Airport (YYZ) in
Canada; and Vancouver International Airport (YVR) in Canada.\20\
---------------------------------------------------------------------------

\20\ This requirement excludes persons transiting through an
airport in the People's Republic of China en route to the United
States from another country. This Order also excludes persons who
have been in the People's Republic of China for less than 24 hours.
Public reporting burden of this collection of information is
estimated to average 2 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information
unless it displays a currently valid OMB Control Number. Comments
regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden, may be submitted to CDC/ATSDR Reports Clearance Officer,
1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA
0920-XXXX.
---------------------------------------------------------------------------

The air passenger or the person acting on behalf of the air
passenger as a legal representative, such as a parent or guardian, must
check A, B, or C and sign the attestation.
I, ____ am attesting on

(Select one):

PRINT FIRST AND LAST NAME
[ballot] My own behalf
[ballot] Behalf of:
-----------------------------------------------------------------------
PRINT FIRST AND LAST NAME

A. Negative Pre-Departure Test Result

[ballot] I attest that I have (or the person I am attesting on behalf
of has) received a negative test result for COVID-19. The test was a
viral test that was done on a sample taken from me (or the person) no
more than 2 calendar days before my (or the person's) flight's
departure.

B. Documentation of Recovery From COVID-19

[ballot] I attest that I have (or the person I am attesting on behalf
of has) met the criteria for documentation of recovery by:
<bullet> testing positive for COVID-19 that was done on a sample
taken from me (or the person) more than 10 calendar days but fewer than
91 calendar days before my (or the person's) flight's departure;
or
<bullet> developing COVID-19 symptoms more than 10 full calendar
days before my (or the person's) flight's departure if my (or the
person's) positive viral test was done on a sample taken from me (or
the person) 10 or fewer calendar days before my (or the person's)
flight.

C. Humanitarian Exception

[ballot] I attest that I have (or the person I am attesting on behalf
of has) received a humanitarian exception to the requirement to show a
negative COVID-19 test result or documentation of recovery, documented
by a letter provided by the U.S. Government.

-----------------------------------------------------------------------
Print Name

[[Page 871]]

-----------------------------------------------------------------------
Signature
-----------------------------------------------------------------------
Dated

Privacy Act Statement for Air Passengers From People's Republic of
China Relating to the Requirement To Provide Proof of a Negative COVID-
19 Test Result or Documentation of Recovery

The U.S. Centers for Disease Control and Prevention (CDC) requires
airlines and other aircraft operators to collect this information
pursuant to 42 CFR 71.20 and 71.31(b), as authorized by 42 U.S.C. 264.
Providing this information is mandatory for all passengers 2 years and
older boarding an aircraft into the United States from the People's
Republic of China, or from Designated Airports if they have been in the
People's Republic of China in the last 10 days.
Failure to provide this information may prevent you from boarding
the plane. Additionally, passengers will be required to attest to
providing complete and accurate information, and failure to do so may
lead to other consequences, including criminal penalties. CDC will use
this information to help prevent the introduction, transmission, and
spread of communicable diseases.
The Privacy Act of 1974, 5 U.S.C. 552a, governs the collection and
use of this information about citizens of the United States and aliens
lawfully admitted for permanent residence. The information maintained
by CDC will be covered by CDC's System of Records No. 09-20-0171,
Quarantine- and Traveler-Related Activities, Including Records for
Contact Tracing Investigation and Notification under 42 CFR parts 70
and 71. See 72 FR 70867 (Dec. 13, 2007), as amended by 76 FR 4485 (Jan.
25, 2011) and 83 FR 6591 (Feb. 14, 2018). CDC will only disclose
information from the system outside the CDC and the U.S. Department of
Health and Human Services as the Privacy Act permits, including in
accordance with the routine uses published for this system in the
Federal Register, and as authorized by law. Such lawful purposes may
include, but are not limited to, sharing identifiable information with
state and local public health departments, and other cooperating
authorities. CDC and cooperating authorities will retain, use, delete,
or otherwise destroy the designated information in accordance with
Federal law and the System of Records Notice (SORN) set forth above.
You may contact the system manager at <a href="/cdn-cgi/l/email-protection#7713101a0607181b1e140e1811111e14123714131459101801">[email&#160;protected]</a> or by
mailing Policy Office, Division of Global Migration and Quarantine,
Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS
H16-4, Atlanta, GA 30329, if you have questions about CDC's use of your
data.

[FR Doc. 2023-00080 Filed 1-3-23; 4:15 pm]
BILLING CODE 4163-18-P

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Indexed from Federal Register on January 5, 2023.

This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.