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Vaccine Attestation 2

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40 views1 page

Vaccine Attestation 2

Uploaded by

nwpyy7z2x6
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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An official website of the United States government

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Vaccine Attestation
Post Arrival Attestation
Attestation is required within 90 days a"er U.S. arrival.

Tuberculosis screening (Select one):

My test result is negative. I have


undergone tuberculosis screening
starting with an IGRA (interferon-gamma
release assay) blood test, and my result is
negative. I have and will retain my IGRA
test result documentation.
My test result is indeterminate. I have
undergone tuberculosis screening
starting with an IGRA (interferon-gamma
release assay) blood test and my results
are indeterminate. An indeterminate IGRA
result means additional testing is needed
because I may have a tuberculosis
infection which has not yet resulted in a
positive IGRA test. I will follow up with a
state or local public health office or
doctor’s office and will complete any
additional recommended testing to
include further IGRA blood testing, chest
x-ray, or other testing and treatment. I
have and will retain my IGRA test result
documentation.
My test result is positive. I have
undergone tuberculosis screening
starting with an IGRA (interferon-gamma
release assay) blood test and this
screening was positive for tuberculosis. I
understand that prior Bacillus Calmette-
Guerin (BCG) vaccination does not cause
a positive IGRA result, thus a positive
IGRA test must be taken seriously. I will
receive a chest x-ray, and if abnormal, or
other signs or symptoms of active
tuberculosis disease are present, I will
comply with isolation and treatment
measures as determined by a state or
local public health office or doctor’s
office. I have and will retain my IGRA test
result documentation as well as
documentation that I followed up for
additional testing and treatment.
I have not undergone tuberculosis
screening but qualify for an exception to
this requirement because I am younger
than 2 years old.

Polio and COVID-19 vaccinations (Select


if applicable):
I did not receive a polio vaccine prior to arriving in the
United States because it was not approved or licensed
for my age group but have now been vaccinated
against polio.

I did not receive a COVID-19 vaccination prior to arrival


in the United States because it was not approved or
licensed for my age group or was only partially
vaccinated prior to arriving in the United States. I have
completed or will complete my COVID-19 primary
series to become fully vaccinated within 90 days of
arrival or within 90 days of reaching the eligible age for
vaccination according to the current guidelines:
https://www.cdc.gov/vaccines/covid-19/clinical-
considerations/interim-considerations-us.html

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