[Federal Register Volume 88, Number 3 (Thursday, January 5, 2023)]
[Notices]
[Pages 864-871]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[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: [email protected].

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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     any aircraft departing from the People's Republic of 
China, or
     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 https://www.cdc.gov/quarantine/china-proof-negative-test.html.

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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     any aircraft departing from the People's Republic of 
China, or
     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:

    (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.

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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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     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.
     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:
     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
     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:
     Preservation of human life;
     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;
     Preserving the health and safety of crew members, 
passengers, airport personnel, and communities; and
     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:
     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.
     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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     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.
     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.
     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): https://www.cdc.gov/flu/weekly/influenza-hospitalization-surveillance.htm.
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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 https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html#when-to-get-tested.
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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 https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html.
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    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\
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    \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\
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    \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:
     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
     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.

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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 [email protected] 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