[Federal Register Volume 86, Number 212 (Friday, November 5, 2021)]
[Notices]
[Pages 61224-61246]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-24385]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


Amended Order Implementing Presidential Proclamation on Advancing 
the Safe Resumption of Global Travel During the COVID-19 Pandemic

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

ACTION: Notice of agency amended order.

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SUMMARY: On October 25, 2021, the President issued a Proclamation, 
``Advancing the Safe Resumption of Global Travel During the COVID-19 
Pandemic.'' Pursuant to this Proclamation, the President has 
implemented a global suspension and restriction on entry for 
noncitizens who are nonimmigrants seeking to enter the United States by 
air travel and who are not fully vaccinated against COVID-19. The 
Proclamation directs the Secretary of Health and Human Services (HHS), 
through the Director of the Centers for Disease Control and Prevention 
(CDC), to implement the Proclamation as it applies to public health. As 
such, CDC announces an Amended Order implementing the Proclamation 
requiring noncitizens who are nonimmigrants seeking to enter the United 
States by air travel to provide proof of being fully vaccinated against 
COVID-19 prior to boarding an aircraft to fly to the United States, 
with only limited exceptions in accordance with the Proclamation. This 
Amended Order was signed by the CDC Director on October 30, 2021, and 
supersedes the previous Order signed by the CDC Director on October 25, 
2021.

DATES: This Amended Order will become effective at 12:01 a.m. EST on 
November 8, 2021.

FOR FURTHER INFORMATION CONTACT: Jennifer Buigut, Division of Global 
Migration and Quarantine, Centers for Disease Control and Prevention, 
1600 Clifton Road NE, MS H16-4, Atlanta, GA 30329. Telephone: 404-498-
1600. Email: [email protected].

SUPPLEMENTARY INFORMATION: The President implemented a global 
suspension and restriction on entry for noncitizens who are 
nonimmigrants seeking to enter the United States by air travel and who 
are not fully vaccinated against COVID-19, with only limited 
exceptions. The Proclamation does not apply to crew members of airlines 
or other aircraft operators if they follow industry standard protocols 
for the prevention of COVID-19.
    In accordance with the Proclamation and CDC's Amended Order, 
Covered Individuals (noncitizens who are nonimmigrants, excluding air 
crew) seeking to enter the United States by air travel and who are not 
fully vaccinated against COVID-19 may board an aircraft destined for 
the United States only if they qualify as Excepted Covered Individuals. 
Noncitizens who are nonimmigrants, excluding air crew, must also 
provide the airline or aircraft operator with a Covered Individual 
Attestation.
    A copy of the Amended Order and Attestation Form is below. A copy 
of these documents and Technical Instructions can be found at: https://www.cdc.gov/quarantine/order-safe-travel.html.

Centers for Disease Control and Prevention (CDC)

Department of Health and Human Services (HHS)

Amended Order Implementing Presidential Proclamation on Advancing the 
Safe Resumption Of Global Travel During the Covid-19 Pandemic

SUMMARY

    On October 25, 2021, the President issued a Proclamation pursuant 
to Sections 1182(f) and 1185(a)(1) of Title 8, and Section 301 of Title 
3, United States Code, (the ``Proclamation''), titled, ``Advancing the 
Safe Resumption of Global Travel During the COVID-19 Pandemic.'' 
Pursuant to this Proclamation, the President has implemented a global 
suspension and restriction on entry for noncitizens who are 
nonimmigrants seeking to enter the United States by air travel and who 
are not fully vaccinated against COVID-19. The Proclamation directs the 
Secretary of Health and Human Services (HHS), through the Director of 
the Centers for Disease Control and Prevention (CDC), to implement the 
Proclamation as it applies to public health in accordance with 
appropriate public health protocols and consistent with CDC's 
independent public health judgment. This Order and accompanying 
Technical Instructions implement the President's direction.
    The Proclamation does not alter the obligation of persons, 
including persons whose entry is not covered by the Proclamation, to 
comply with the applicable requirements of CDC Orders, including:
     Requirement for Proof of Negative COVID-19 Test or 
Recovery from COVID-19 for All Air Passengers Arriving in the United 
States (published at 86 FR 7387, January 28, 2021) (as may be further 
amended);
     Requirement for Persons to Wear Masks While on Conveyances 
and at Transportation Hubs (published at 86 FR 8025, February 3, 2021) 
(as may be further amended); and
     Other CDC Orders that may be published relating to 
preventing the introduction, transmission, and spread of COVID-19 into 
and throughout the United States.
    This Amended Order supersedes the previous Order signed by the CDC 
Director on October 25, 2021, implementing the President's direction. 
This Order shall enter into effect at 12:01 a.m. EST (5:01 a.m. GMT) on 
November 8, 2021.

Definitions

    Accepted COVID-19 Vaccine means:
     A vaccine authorized for emergency use or approved by the 
U.S. Food and Drug Administration; \1\ or
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    \1\ For a list of vaccines approved or authorized in the United 
States to prevent COVID-19, see https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html
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     A vaccine listed for emergency use (EUL) by the World 
Health Organization (WHO); \2\ or
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    \2\ See WHO's website for more information about WHO-listed 
COVID-19 vaccines.
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     A vaccine or combination of vaccines \3\ listed by CDC in 
Technical Instructions to this Order.
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    \3\ CDC has not recommended the use of heterologous (i.e., 
``mix-and-match'') primary series. However, the use of such 
strategies (including mixing of mRNA, adenoviral, and mRNA plus 
adenoviral products) is increasingly common in many countries 
outside of the United States. Accordingly, additional vaccinations 
or combinations of vaccinations may be listed in CDC's Technical 
Instructions to this Order for purposes of the interpretation of 
vaccination records.
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    Covered Individual means any passenger covered by the Proclamation 
and this Order: A noncitizen \4\ who is a nonimmigrant seeking to enter 
the United States by air travel. This term does not apply to crew 
members of airlines or other aircraft operators if such crewmembers and 
operators adhere to all industry standard protocols for the prevention 
of COVID-19, as set forth in relevant guidance for crewmember health 
issued by the CDC

[[Page 61225]]

or by the Federal Aviation Administration in coordination with the CDC.
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    \4\ For purposes of the Order, U.S. lawful permanent residents 
and U.S. nationals will be treated in the same manner as U.S. 
citizens.
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    Excepted Covered Individual means a Covered Individual who is not 
fully vaccinated against COVID-19 and meets the criteria for an 
exception under the Proclamation and this Order.
    Covered Individual Attestation means the attestation in Attachment 
A, \5\ in written or electronic form, that must be completed by each 
Covered Individual who is permitted to enter the United States under 
the Proclamation and this Order.
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    \5\ 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 will 
have sole legal responsibility to provide and collect attestations, 
to ensure the accuracy of any translation, and to comply with all 
other obligations under agency directives implementing the 
Proclamation. An airline or aircraft operator is responsible for any 
failure of a third party to comply with such directives. An airline 
or aircraft operator may not shift any legal responsibility to a 
third party.
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    Foreign country means anywhere that is not a state, territory, or 
possession of the United States.
    Foreign Country with Limited COVID-19 Vaccine Availability means a 
foreign country where less than 10 percent of the country's total 
population has been fully vaccinated with any available COVID-19 
vaccine. These countries are listed by CDC in Technical Instructions.
    Fully Vaccinated Against COVID-19 means it has been:
     2 weeks (14 days) or more since a person received one dose 
of an accepted single-dose-series COVID-19 vaccine; OR
     2 weeks (14 days) or more since a person's second dose in 
a 2-dose series of an accepted COVID-19 vaccine; OR
     2 weeks (14 days) or more since a person received the full 
series of an ``active'' (not placebo) COVID-19 vaccine in the U.S.-
based AstraZeneca or Novavax COVID-19 vaccine trials; OR
     2 weeks (14 days) or more since the person received a 
complete series of a vaccine or combination of vaccines listed by CDC 
in Technical Instructions.
    Not Fully Vaccinated Against COVID-19 means a person does not meet 
the definition of Fully Vaccinated Against COVID-19.
    Proof of Being Fully Vaccinated Against COVID-19 means a paper or 
digital format of a vaccination record or a verifiable vaccination 
record, as listed by CDC in Technical Instructions, confirming that the 
person is Fully Vaccinated Against COVID-19.
    Self-isolation means, for purposes of this Order, actions taken by 
an Excepted Covered Individual who tests positive on a viral test for 
COVID-19 administered on a specimen collected 3-5 days after arriving 
in the United States or develops COVID-19 symptoms. These actions 
include:
     separating from other individuals, staying in a home or 
other residence for at least 10 days after symptom onset and after 
resolution of fever for at least 24 hours and improvement of other 
symptoms; or
     separating from other individuals, staying in a home or 
other residence for 10 days after the first positive test if 
asymptomatic;
    AND
     observing other public health precautions as set forth in 
CDC guidance.\6\
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    \6\ Quarantine and Isolation, available at https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html.
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    Self-quarantine means, for purposes of this Order, actions taken by 
an Excepted Covered Individual to separate from other individuals after 
arriving in the United States, including staying in a home or other 
residence for a full 7 days and observing public health precautions as 
set forth in CDC guidance.\7\
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    \7\ Ibid.
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    Viral test means a viral detection test for current infection 
(i.e., a nucleic acid amplification test [NAAT] or a viral antigen 
test) approved or authorized by the U.S. Food and Drug Administration 
for the detection of SARS-CoV-2.
    United States or U.S. 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.''

Background

    Since January 2020, the respiratory disease known as ``COVID-19,'' 
caused by a novel coronavirus (SARS-CoV-2), has spread globally, 
including cases reported in all 50 states within the United States, 
plus the District of Columbia and all U.S. territories. As of October 
22, 2021, there have been over 242,000,000 million cases of COVID-19 
globally, resulting in over 4,900,000 deaths.\8\ More than 45,000,000 
cases have been identified in the United States, with new cases 
reported daily, and over 733,000 deaths attributed to the disease.\9\ A 
renewed surge in cases in the United States began in early July 2021; 
daily case counts rose from 19,000 cases on July 1, 2021 to 159,000 
cases on September 1, 2021. While cases are currently decreasing in the 
United States, during the entirety of this pandemic, cases have tended 
to surge in waves, including after high-volume travel periods, with 
four waves as of October 2021.\18\ Therefore, additional surges of 
cases and deaths are very possible.
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    \8\ COVID-19 Map--Johns Hopkins Coronavirus Resource Center 
(jhu.edu).
    \9\ CDC COVID Data Tracker.
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    The United States is taking a multi-layered approach to combatting 
COVID-19, concurrently preventing and slowing the continued 
introduction of cases and further spread of the virus within U.S. 
communities. Vaccination is the most important measure for reducing 
risk for SARS-CoV-2 transmission and in avoiding severe illness, 
hospitalization, and death. Studies so far show that vaccinated people 
are five times less likely to be infected and more than 10 times less 
likely to experience hospitalization or death than people who are not 
fully vaccinated against COVID-19.\10\
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    \10\ The Possibility of COVID-19 after Vaccination: Breakthrough 
Infections, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html.
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    On October 25, 2021, the President issued a Proclamation under 3 
U.S.C. 301 and 8 U.S.C. 1182(f), 1185(a)(1), titled, ``Advancing the 
Safe Resumption of Global Travel During the COVID-19 Pandemic.'' The 
Proclamation revokes prior, country-specific presidential proclamations 
issued under these authorities in response to the outbreak of COVID-19. 
In their place, the President has implemented a global suspension and 
restriction on entry for noncitizens who are nonimmigrants seeking to 
enter the United States by air travel and who are not fully vaccinated 
against COVID-19, with only limited exceptions. This Amended Order and 
accompanying technical instructions implement the President's 
Proclamation. As further explained in this Amended Order, CDC will be 
implementing the Proclamation, among other ways, through a requirement 
that certain Excepted Covered Individuals who are unable to present 
Proof of Being Fully Vaccinated Against COVID-19 instead present a 
Covered Individual Attestation to the airline or aircraft operator 
prior to boarding the aircraft.

[[Page 61226]]

Persons Whose Entry Is Not Covered by the Proclamation or Who are 
Eligible for an Exception to the Requirement To Present Proof of Being 
Fully Vaccinated Against COVID-19

    The Proclamation applies only to non-U.S. citizens seeking entry as 
nonimmigrants. Individuals seeking entry to the United States as 
immigrants are subject to the medical examination and vaccination 
requirements of 8 U.S.C. 1182(a)(1)(A) and 42 CFR part 34. These 
requirements are further described in CDC's COVID-19 Technical 
Instructions for Panel Physicians.\11\
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    \11\ https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/covid-19-technical-instructions.html.
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    The Proclamation does not apply to crew members of airlines or 
other aircraft operators if they follow industry standard protocols for 
the prevention of COVID-19.\12\ Accordingly, per the terms of the 
Proclamation, these individuals are not Covered Individuals and are not 
required to present Proof of Being Fully Vaccinated nor required to 
present a completed Covered Individual Attestation to the airline or 
aircraft operator before boarding an aircraft destined to the United 
States.
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    \12\ Crew members on official duty assigned by the airline or 
operator that involves operation of aircraft, or the positioning of 
crew not operating the aircraft (i.e., on ``deadhead'' status), are 
exempt from the requirements of the Order 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 as set forth in relevant Safety 
Alerts for Operators (SAFOs) issued by the Federal Aviation 
Administration (FAA), i.e., SAFO 20009, COVID-19: Updated Interim 
Occupational Health and Safety Guidance for Air Carriers and Crews, 
available at https://www.faa.gov/other_visit/aviation_industry/airline_operators/airline_safety/safo/all_safos/media/2020/SAFO20009.pdf. CDC will provide further information in Technical 
Instructions.
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    The Proclamation permits Excepted Covered Individuals to enter the 
United States by air if they meet certain criteria as determined by the 
CDC. Except where otherwise indicated, these Excepted Covered 
Individuals will be required to present a Covered Individual 
Attestation to the airline or aircraft operator before boarding an 
aircraft destined to the United States. These categories include:
    Diplomatic and Official Foreign Government Travel. The Proclamation 
excepts any noncitizen seeking entry into or transiting the United 
States for certain diplomatic or official foreign government 
activities. This includes:
     Noncitizens traveling pursuant to one of the following 
nonimmigrant visa classifications: A-1, A-2, C-2, C-3 (as a foreign 
government official or immediate family member of an official), E-1 (as 
an employee of TECRO or TECO or the employee's immediate family 
members), G-1, G-2, G-3, G-4, NATO-1 through NATO-4, or NATO-6 (or 
seeking to enter as a nonimmigrant in one of those NATO 
classifications); or
     Any noncitizen whose travel falls within the scope of 
section 11 of the United Nations Headquarters Agreement or other travel 
pursuant to a United States legal obligation (as evidenced by a letter 
of invitation from the United Nations or other documentation showing 
the purpose of such travel). Such an individual will need to present an 
official letter, such as a letter from the U.S. government or foreign 
government to the airline or aircraft operator. If invited by the 
United Nations, such an individual will need to present to the airline 
or aircraft operator a letter of invitation from the United Nations or 
other documentation showing the purpose of such travel.
    These persons will be required to provide the Covered Individual 
Attestation to the airline or aircraft operator before boarding an 
aircraft destined to the United States. Such individuals must also 
attest to agreeing and arranging to be vaccinated within 60 days of 
arriving in the United States, or as soon thereafter as is medically 
appropriate as determined by CDC, if they intend to stay in the United 
States for more than 60 days and have received no vaccine series. If 
such an individual has previously received a COVID-19 vaccine that is 
authorized or approved by the noncitizen's country of nationality but 
is not an Accepted COVID-19 Vaccine, then the individual will not need 
to agree or arrange to be vaccinated in the United States. In addition, 
if the CDC Director, in consultation with the Secretary of State, 
determines that the individual cannot complete the requirements of the 
Covered Individual Attestation consistent with the purposes of their 
official foreign government activities, then the individual is not 
required to attest to agreeing and arranging to complete the 
requirements of the Covered Individual Attestation.
    Children. The Proclamation excepts noncitizens who are 
nonimmigrants for whom, given their age, requiring vaccination would be 
inappropriate, as determined by the CDC, taking into account global 
vaccine availability for individuals in that age group. In the United 
States, COVID-19 vaccinations are widely available for adolescents, 
with a vaccine approved for those 16 years and older and authorized for 
those 12 to 15 years of age. However, the same availability does not 
exist globally. Accordingly, considering the difficulty potentially 
posed to families traveling together when some members of the family 
can be vaccinated and others cannot, persons under the age of 18 years 
meet the age-based exception in the Proclamation.
    Noncitizens who are nonimmigrants and who are under the age of 18 
years and unable to present Proof of Being Fully Vaccinated Against 
COVID-19 must present a completed Covered Individual Attestation to the 
airline or aircraft operator prior to embarking an aircraft destined to 
the United States. However, as part of this attestation, children under 
the age of 18 will not be required to attest (or have a parent or 
guardian attest on their behalf) to having arranged to self-quarantine 
in the United States after arrival. Based on the potential difficulty 
that self-quarantine may pose to children under 18 years of age 
especially when accompanied by a vaccinated parent or guardian who is 
not required to self-quarantine, CDC has determined that self-
quarantine should not be required. Nevertheless, children under 18 
years of age will be required to attest (or have a parent or guardian 
attest on their behalf) to arranging to be tested for COVID-19 3-5 days 
after arrival and to self-isolate if the test result should be positive 
or if the child develops COVID-19 symptoms. CDC believes that this 
approach fairly balances the interests of families traveling to the 
United States with protecting the public's health. CDC guidance 
strongly recommends vaccination for all eligible children under 18. 
However, given the still evolving circumstances of vaccination for 
children, attestation regarding post-arrival vaccination will also not 
be required for children under 18 at this time. This determination will 
be periodically reevaluated.
    Clinical Trials. The Proclamation excepts noncitizens who are 
nonimmigrants and who have participated or are participating in certain 
clinical trials for COVID-19 vaccination, as determined by the CDC. 
Qualifying vaccine candidates will be specified in CDC's Technical 
Instructions to this Order. Because these clinical trial participants 
may have taken a COVID-19 vaccine or series of COVID-19 vaccines that 
do not meet the definition of an Accepted COVID-19 Vaccine, these 
participants may not be able to present Proof of Being Fully Vaccinated 
Against COVID-19. Accordingly, noncitizens who are nonimmigrants and 
who have participated or are participating in certain COVID-19 vaccine 
trials and unable to present Proof of Being Fully Vaccinated Against 
COVID-19 must

[[Page 61227]]

present a completed Covered Individual Attestation to the airline or 
aircraft operator prior to embarking an aircraft destined to the United 
States. However, CDC has determined that these individuals should not 
be required to attest to agreeing and arranging to self-quarantine or 
to be vaccinated after arriving in the United States. Requiring self-
quarantine after arrival could potentially discourage clinical trial 
participants which would not serve the interests of public health and 
requiring vaccination could potentially invalidate the clinical trial 
study. Nevertheless, these individuals will be required to attest to 
arranging to be tested for COVID-19 3-5 days after arrival and to self-
isolate if the test result should be positive or if they develop COVID-
19 symptoms.
    Medical Contraindications. The Proclamation excepts noncitizens who 
are nonimmigrants for whom receiving an accepted COVID-19 vaccine is 
medically contraindicated as determined by a licensed physician.\13\ 
Accordingly, individuals with medical contraindications to an accepted 
COVID-19 vaccine (e.g., a demonstrated anaphylactic reaction to a prior 
dose of a COVID-19 vaccine or vaccine component), as further described 
in CDC's Technical Instructions to this Order, are not required to 
present Proof of Being Fully Vaccinated Against COVID-19. COVID-19 
vaccinations have been overwhelmingly proven to be safe and effective 
at preventing severe illness, hospitalizations, and deaths from COVID-
19. However, as is the case with any vaccine, certain medical 
complications can occur, such as a severe allergic reaction. CDC 
intends for this exception to be applied in strict accordance with 
scientific evidence and will provide additional details concerning 
exceptions for medical contraindications in CDC's Technical 
Instructions to this Order. Persons granted an exception based on 
medical contraindications will be required to present a Covered 
Individual Attestation to the airline or aircraft operator prior to 
embarking an aircraft destined to the United States but are not 
required to attest to agreeing and arranging to be vaccinated after 
arriving in the United States.
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    \13\ Objections to vaccination based on religious or moral 
convictions do not qualify under this or any other exception listed 
in the Proclamation or this Order.
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    Humanitarian and Emergency Exceptions. The Proclamation excepts any 
noncitizen nonimmigrant who has been granted an exception by the CDC 
for humanitarian or emergency reasons, as determined by the CDC. CDC 
will apply this exception extremely narrowly, such as when an 
individual must travel to the United States to preserve health and 
safety (e.g., emergency medical evacuations) and is unable to complete 
the vaccination requirement before travel. Individuals and 
organizations sponsoring individuals who fit the exception criteria 
should contact the U.S. embassy or consulate in or nearest the country 
from which they are departing for the United States. The embassy will 
then transmit this information to the CDC for consideration. Any 
noncitizen who is a nonimmigrant granted an exception for humanitarian 
or emergency reasons must present an official U.S. government letter 
and a completed Covered Individual Attestation to the airline or 
aircraft operator prior to embarking an aircraft destined to the United 
States. Such individual must also attest to agreeing and arranging to 
be vaccinated within 60 days of arriving in the United States, or as 
soon thereafter as is medically appropriate as determined by CDC, if 
they intend to stay in the United States for more than 60 days.
    Limited Vaccine Availability. The Proclamation excepts any 
noncitizen who is a nonimmigrant with a nonimmigrant visa (excluding a 
B-1 or B-2 visa) and who is a citizen of a Foreign Country with Limited 
COVID-19 Vaccine Availability, which is defined pursuant to the 
Proclamation and this Order as a foreign country where less than 10 
percent of the country's total population has been fully vaccinated 
with any available COVID-19 vaccine or is otherwise determined by the 
Director of the CDC to qualify as a country where the availability of 
COVID-19 vaccination is limited. The list of countries falling below 
the 10 percent threshold will be maintained by CDC in Technical 
Instructions to this Order and will be reviewed on a regular basis. In 
developing and maintaining this list, CDC will rely on official source 
data as reported by foreign ministries of health but may also rely on 
other sources such as additional information provided by U.S. embassies 
and consulates. Currently, 50 countries report having less than 10 
percent of their populations fully vaccinated against COVID-19.\14\
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    \14\ CDC COVID Data Tracker: Global COVID-19 Vaccination.
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    Individuals entering the United States under this exception must 
present a completed Covered Individual Attestation to the airline or 
aircraft operator prior to embarking an aircraft destined to the United 
States. Additionally, these individuals must attest to agreeing and 
arranging to be vaccinated within 60 days of arriving in the United 
States, or as soon thereafter as is medically appropriate as determined 
by CDC, if they intend to stay in the United States for more than 60 
days.
    Members of the U.S. Armed Forces. The Proclamation excepts 
noncitizens who are members of the U.S. Armed Forces and spouses or 
children of members of the U.S. Armed Forces. CDC intends to apply this 
exception in a similar manner as in the CDC Order, ``Requirement for 
Proof of Negative COVID-19 Test or Recovery from COVID-19 for All Air 
Passengers Arriving in the United States.'' U.S. Armed Forces observe 
U.S. Department of Defense guidance to prevent the transmission of 
COVID-19 as set forth in Force Protection Guidance Supplement 20--
Department of Defense Guidance for Personnel Traveling During the 
Coronavirus Disease 2019 Pandemic (April 12, 2021). Accordingly, 
members of the U.S. Armed Forces, and their spouses and children, if 
traveling with a U.S. military identification document or other proof 
of status as a member or spouse or child (under 18 years of age) of a 
member of the U.S. Armed Forces, must attest to their status on the 
Covered Individual Attestation, but will not be required to attest to 
agreeing and arranging to complete the requirements of the Covered 
Individual Attestation.
    Sea Crew Members. The Proclamation excepts any noncitizen seeking 
entry as a sea crew member traveling pursuant to a C-1 and D 
nonimmigrant visa, if such crew member adheres to all industry standard 
protocols for the prevention of COVID-19, as set forth in relevant 
guidance for crew member health by the CDC.\15\ Any passenger granted 
an exception as a Sea Crew Member must present documentation to the 
airline from their employer indicating that their entry to the United 
States is required for the purpose of operating a vessel that will 
depart from a U.S. seaport. Individuals entering the United States 
under this exception must present a completed Covered Individual 
Attestation to the airline or aircraft

[[Page 61228]]

operator prior to embarking an aircraft destined to the United States. 
Additionally, these individuals must attest to agreeing and arranging 
to be vaccinated within 60 days of arriving in the United States, or as 
soon thereafter as is medically appropriate as determined by CDC, if 
they intend to stay in the United States for more than 60 days.
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    \15\ See CDC's Technical Instructions for this Order for 
additional information regarding post-arrival public health 
management of sea crew. Relevant CDC guidance pertaining to sea crew 
members serving on board cruise ships has been issued as part of the 
Temporary Extension and Modification of the Conditional Sail Order 
(available at https://www.cdc.gov/quarantine/cruise/covid19-cruiseships.html). Additional guidance applicable to crew serving 
onboard all vessels is available at https://www.cdc.gov/quarantine/maritime/recommendations-for-ships.html.
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    National Interest Exception. The Proclamation excepts any 
noncitizen or group of noncitizens whose entry is in the U.S. national 
interest, as determined by the Secretary of State, the Secretary of 
Transportation, or the Secretary of Homeland Security, or their 
designees. Any Excepted Covered Individual granted an exception in the 
national interest must present an official U.S. government letter and a 
completed Covered Individual Attestation to the airline or aircraft 
operator prior to embarking an aircraft destined to the United States. 
Such an individual must also attest to agreeing and arranging to be 
vaccinated within 60 days of arriving in the United States, or as soon 
thereafter as is medically appropriate, if they intend to stay in the 
United States for more than 60 days.

Requirement To Provide an Covered Individual Attestation for an 
Excepted Covered Individual Who Is Unable To Present Proof of Being 
Fully Vaccinated

    Covered Individuals seeking to enter the United States by air 
travel and who are not Fully Vaccinated Against COVID-19 may embark an 
aircraft destined for the United States only if they qualify as 
Excepted Covered Individuals pursuant to the Proclamation. Under the 
Proclamation, such individuals must agree that they will comply with 
applicable public health precautions established by CDC to protect 
against the public health risk posed by these travelers entering into 
the United States. These include:
     Providing proof in the form of an attestation of pre-
departure testing for COVID-19, as determined by the CDC;
     taking precautions during air travel to protect against 
the further introduction, transmission, and spread of COVID-19, 
including by complying with the requirement to wear a face mask, as 
determined by the CDC;
     providing proof in the form of an attestation of having 
arranged for post-arrival testing for COVID-19, as determined by the 
CDC; and
     providing proof in the form of an attestation of having 
arranged to self-quarantine or self-isolate after arriving in the 
United States, as determined by the CDC.
    Some categories of Excepted Covered Individuals (subject to certain 
exceptions) must agree to become fully vaccinated against COVID-19 
within 60 days \16\ of arriving in the United States if the individual 
intends to stay in the United States for more than 60 days, or as soon 
thereafter as is medically appropriate as determined by the CDC, and 
must provide proof in the form of an attestation of having agreed and 
arranged to become fully vaccinated against COVID-19 after arriving in 
the United States.
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    \16\ CDC concurs that 60 days is the appropriate time frame for 
requiring that persons arriving in the United States be fully 
vaccinated against COVID-19. The mRNA COVID-19 vaccines (Pfizer-
BioNTech and Moderna) available in the United States are 
administered 3-4 weeks apart (see https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html). It takes 14 days after 
the 2nd dose to be considered fully vaccinated. Therefore, it is 
reasonable to conclude that individuals should be able to complete 
the vaccination series and the 14-day period within 60 days of 
arriving in the United States.
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    The Proclamation directs the HHS Secretary, acting through the CDC 
Director, to implement the Proclamation as it applies to public health 
consistent with CDC's independent public health judgment. In accordance 
with the President's direction, this Amended Order requires that, to 
travel to the United States by air travel, an Excepted Covered 
Individual who is unable to present Proof of Being Fully Vaccinated 
Against COVID-19 must present a Covered Individual Attestation to the 
airline or aircraft operator prior to embarking the aircraft.
    The Covered Individual Attestation must be completed, in written or 
electronic form, by the Excepted Covered Individual and is subject to 
18 U.S.C. 1001. As further explained in the attached Attestation form 
(Attachment A), persons who knowingly submit false information may be 
subject to fines, imprisonment, and other penalties. Airlines or other 
aircraft operators, as directed by the Transportation Security 
Administration (TSA), including through a forthcoming Security 
Directive to be issued after consultation with CDC, and consistent with 
this Amended Order, will be required to retain a copy of the Covered 
Individual Attestation for 2 years; however, individuals are not 
required to retain a copy of the attestation in their possession upon 
arriving in the United States.
    Future CDC orders implementing the Proclamation may require other 
public health measures consistent with the Proclamation to protect 
against the further introduction, transmission, and spread of COVID-19 
into the United States by Covered Individuals.
    This Amended Order clarifies certain ambiguity that existed at the 
time of the issuance of the Order on October 25, 2021, regarding the 
requirement for post-arrival quarantine for children under 18 years of 
age and participants in certain COVID-19 clinical trials. This Amended 
Order clarifies that such individuals are not required to attest to 
having to agree and arrange to self-quarantine after arriving in the 
United States. Therefore, to the extent that this ambiguity would have 
caused these individuals to self-quarantine, this ambiguity is now 
clarified and accordingly relieves these individuals of what may have 
otherwise been perceived as an obligation. It is imperative that these 
amendments be issued without delay so that these individuals may have 
the necessary clarity to arrange their travel plans in accordance with 
the requirements of this Amended Order.
    This Amended Order is not a rule within the meaning of the 
Administrative Procedure Act (``APA'') but rather an Order implementing 
the President's Proclamation, which itself is not subject to the APA. 
Additionally, considering the President's Proclamation is effective on 
November 8, 2021, it is imperative that CDC issue this Amended Order 
without delay. If this Amended 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 and unpredictable developments in the public 
health emergency caused by COVID-19, 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 Amended 
Order implementing the President's Proclamation. Further delay could 
increase risk of transmission and importation of additional undetected 
cases of SARS-CoV-2 Delta variant or other emerging variants through 
not fully vaccinated passengers.
    This Amended 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. 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

[[Page 61229]]

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).
    If any provision of this Amended Order implementing the President's 
Proclamation, or the application of any provision to any carriers, 
persons, or circumstances, shall be held invalid, 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.
    Pursuant to 5 U.S.C. 553(b)(B), and for the reasons stated above, I 
hereby conclude that notice-and-comment rulemaking would defeat the 
purpose of this Amended Order implementing the President's Proclamation 
and endanger the public health, and is, therefore, impracticable and 
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 Amended Order implementing the President's 
Proclamation effective without a 30-day delay in effective date.

Action

    Accordingly, for the reasons set forth in the Proclamation and in 
this Order:

1. Directions to Airlines & Other Aircraft Operators

    As directed by TSA, including through a forthcoming Security 
Directive to be issued after consultation with CDC, and consistent with 
this Order, any airline or other aircraft operator transporting by air 
into the United States individuals who are Covered Individuals from any 
foreign country, as determined and confirmed by the airline or other 
aircraft operator, will be required to:
    A. Confirm that every Covered Individual, unless excepted, prior to 
boarding the aircraft, has presented paper or digital documentation of 
Proof of Being Fully Vaccinated Against COVID-19 that includes personal 
identifiers (e.g., name and date of birth) that matches the personal 
identifiers on the passenger's passport or other travel documents, and 
provides a Covered Individual Attestation.
    B. Confirm that every Covered Individual who has not presented 
Proof of Being Fully Vaccinated Against COVID-19 prior to boarding the 
aircraft, has presented documentation proving that they are an Excepted 
Covered Individual under the Proclamation and this Order as further 
explained by CDC in Technical Instructions for this Order.
    C. Confirm that every Excepted Covered Individual who has not 
presented Proof of Being Fully Vaccinated Against COVID-19, prior to 
boarding the aircraft, provides a Covered Individual Attestation, as 
applicable and as further explained in CDC Technical Instructions to 
this Order, attesting to the following:
    a. Being excepted from the requirement to present Proof of Being 
Fully Vaccinated Against COVID-19 for one of the reasons set forth in 
the Proclamation and this Order;
    b. having arranged to be tested with a COVID-19 viral test 3-5 days 
after arriving in the United States, unless the Excepted Covered 
Individual has documentation of having recovered from COVID-19 in the 
past 90 days;
    c. having arranged to self-quarantine, even if the test result to 
the post-arrival viral test is negative, unless the Excepted Covered 
Individual has documentation of having recovered from COVID-19 in the 
past 90 days; and
    d. having arranged to self-isolate if the result of the post-
arrival viral test is positive or if they develop COVID-19 symptoms.
    D. Confirm that every Excepted Covered Individual who does not 
present Proof of Being Fully Vaccinated Against COVID-19, provides a 
Covered Individual Attestation, as applicable and as further explained 
in CDC Technical Instructions to this Order, attesting to the 
following:
    a. Agreeing to be vaccinated and having arranged to become fully 
vaccinated against COVID-19 within 60 days after arriving in the United 
States, or as soon thereafter as is medically appropriate as determined 
by CDC, if such person intends to stay in the United States for more 
than 60 days, unless the individual is excepted from this requirement.
    E. Not board any Covered Individual without confirming the 
documentation as set forth in A, B, C, or D of this section.
    The attestation is attached to this order as Attachment A.\17\
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    \17\ CDC has provided a combined passenger disclosure and 
attestation that fulfills the requirements of CDC Orders: 
Requirement for Proof of Negative COVID-19 Test Result or Recovery 
from COVID-19 for All Airline Passengers Arriving into the United 
States and Order Implementing Presidential Proclamation on Advancing 
the Safe Resumption of Global Travel During the COVID-19 Pandemic.
---------------------------------------------------------------------------

2. Requirements for Aircraft Passengers

    In addition, I order that any aircraft passenger \18\ who is a 
Covered Individual under the Proclamation, prior to boarding an 
aircraft traveling from a foreign country to the United States, shall--
---------------------------------------------------------------------------

    \18\ A parent or other authorized individual may present the 
required documentation on behalf of a passenger under 18 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).
---------------------------------------------------------------------------

    A. Present to the airline or other aircraft operator a paper or 
digital documentation reflecting Proof of Being Fully Vaccinated 
Against COVID-19 and provides a Covered Individual Attestation.
    OR
    B. If not presenting Proof of Being Fully Vaccinated Against COVID-
19, present to the airline or aircraft operator documentation 
confirming that they are an Excepted Covered Individual under the 
Proclamation and this Order, as applicable and as further explained by 
CDC in Technical Instructions for this Order.
    C. If an Excepted Covered Individual, accurately complete and 
provide the airline or aircraft operator with a Covered Individual 
Attestation, as applicable and as further explained by CDC in Technical 
Instructions for this Order, attesting that the Excepted Covered 
Individual:
    a. Is excepted from the requirement to present Proof of Being Fully 
Vaccinated Against COVID-19 for one of the reasons set forth in the 
Proclamation and this Order;
    b. agrees and has arranged to be tested with a COVID-19 viral test 
3-5 days after arriving in the United States, unless the Excepted 
Covered Individual has documentation of having recovered from COVID-19 
in the past 90 days;
    c. agrees and has arranged to self-quarantine, even if the test 
result to the post-arrival viral test is negative, unless the Excepted 
Covered Individual has documentation of having recovered from COVID-19 
in the past 90 days; and
    d. agrees and has arranged to self-isolate if the result of the 
post-arrival viral test is positive or if they develop COVID-19 
symptoms.
    D. If an Excepted Covered Individual, provide the airline or 
aircraft operator with a Covered Individual Attestation, as applicable 
and as further explained by CDC in Technical Instructions for this 
Order, additionally attesting that the Excepted Covered Individual:
    (1) Agrees to be vaccinated and has arranged to become fully 
vaccinated against COVID-19 within 60 days after

[[Page 61230]]

arriving in the United States, or as soon thereafter as is medically 
appropriate as determined by CDC, if intending to stay in the United 
States for more than 60 days, unless the individual is excepted from 
this requirement.
    E. Retain a copy of the applicable documentation listed in parts A, 
B, C, and D of this section and produce such documentation upon 
request, or as required by, any U.S. government official or a 
cooperating state, local, territorial, or tribal public health 
authority after arrival in the United States.
    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 enforced through the relevant provisions of 
law, in coordination with other federal departments and agencies, 
including the U.S. Department of Justice, U.S. Department of Homeland 
Security, U.S. Department of State, and U.S. Department of 
Transportation.

Effective Date

    This Order shall enter into effect at 12:01 a.m. EST (5:01 a.m. 
GMT) on November 8, 2021.
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Authority

    The authority for the Presidential Proclamation is Sections 1182(f) 
and 1185(a)(1) of Title 8, and Section 301 of Title 3, United States 
Code. CDC's Order is issued pursuant to the Presidential Proclamation.

Sherri Berger,
Chief of Staff, Centers for Disease Control and Prevention.
[FR Doc. 2021-24385 Filed 11-3-21; 4:15 pm]
BILLING CODE 4163-18-C