According to the Paperwork Reduction Act o
f
1995, an
agency may not conduct or sponsor, and a person is not required to respond to, a collection of
i
nformatio
n
un
less it
displays a valid OMB control number. The estimated burden to complete this form is
15
minutes. The OMB control number for this information collection is 2105-0576.
The
authority for the collection expires on December 31, 2023.
Warning: It is a Federal crime to make materially false, fictitious, or fraudulent statements, entries, or representations knowingly and
willfully on this form to secure disability accommodations provided under regulations of the United States Department of Transportation
(18 U.S.C. § 1001).
U.S. Department of Transportation Service Animal Air Transportation Form
Service Animal Handler’s Name: Phone:
Service Animal User’s Name
(if different from Handler): Phone:
Service Animal Handler’s Email: Animal’s Name
Description of the Animal (including weight):
Animal Health
[Insert Animal’s Name]
is vaccinated for rabies. Date of last vaccination: Date vaccination expires in the dog:
To my knowledge,
[Inser
t Animal’s Name]
does not have fleas or ticks or a disease that would endanger people or other animals.
Veterinarian’s Name (signature not required): Phone:
Animal Training and Behavior
[Inser
t Animal’s Name]
has been trained to do work or perform tasks to assist me with my disability.
Name of Animal Trainer or Training Organization: Phone:
[Inser
t Animal’s Name]
has been trained to behave in a public setting.
I understand that a properly trained dog remains under the control of its handler. I understand that a properly trained dog does not
act aggressively by biting, barking, jumping, lunging, or injuring people or other animals. It also does not urinate or defecate on
the aircraft or in the gate area.
I understand that if
[Inse
rt Animal’s Name]
shows that it has not been properly trained to behave in public, then the airline may treat
[Insert
Animal’s Name]
as a pet by charging a pet fee and requiring
[I
nsert Animal’s Name]
to be transported in a pet carrier.
To the best of my knowledge,
[Inser
t Animal’s Name]
has not behaved aggressively or caused serious injury to another person/dog.
If you cannot check the box above, please explain:
Other Assurance
I understand that
[Inser
t Animal’s Name]
must be harnessed, leashed, or tethered at all times in the airport and on the aircraft.
I understand that if
[Insert Animal’s Name]
causes damage, then the airline may charge me for the cost to repair it, as long as the airline
would also charge passengers without disabilities to repair the similar kinds of damage.
I
am signing an official document of the U.S. Department of Transportation. My answers
are true to the best of my knowledge. I
understand that if I knowingly make false statements on this document, I can be subject to fines and other penalties.
Signature of the Service Animal Handler: Date:
Submit this form at least 48 hours before your flight.
By submitting this form, you agree to the use of personal information in connection with travel.
See our privacy policy aa.com/privacy for more information.
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___________________
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□ ___________________
________________________________________________________________
□ ___________________
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__________________________________ _________________________________
click to sign
signature
click to edit
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