Pago Pago, AMERICAN SAMOA — A signed sworn affidavit is required, for any traveler 5 years and older seeking exemption from full COVID-19 vaccination due to religious beliefs or observance, according to the ASG waiver form, as future travelers posted complaints on social media about all these additional requirements to enter the territory.

Provisions of the current COVID-19 Emergency Declaration state that requests for “vaccine accommodations for medical condition or a sincerely held religious belief may be made on forms approved” by the Governor’s Authorized Representative (GAR) — who is Lt. Gov. Talauega Eleasalo Ale.

Requests for accommodation must be received at least 14-days before travel. To request a form for vaccine accommodations, contact the Governor’s Office at — covidtravel@go.as.gov - or call (684) 633-4121.

Last week, the Governor’s Office made public the waiver form, which shows what’s needed to complete it before submission for review and approval. Future travelers to the territory raised concerns regarding the wavier for religious beliefs and the requirement of a sworn affidavit.

The waiver for “religious belief, practice or observance” form asks three specific questions. For example, the traveler is asked to identify his/ her “sincerely held religious belief, practice, or observance that is the basis for your request for religious accommodation and how long you have held this.”

It also asks to explain how the traveler’s religious belief, practice, or observance conflicts with the ASG’s COVID-19 vaccine mandate for travel. Additionally, the traveler is to describe how the “sincerely held religious belief, practice, or observance has affected your receipt of other vaccines, including the measles, mumps, rubella vaccine, which is required for post-secondary school attendance in most states.”

Also required to be submitted with the waiver-form is a sworn affidavit, which must be signed by a notary public. And the affidavit states in part that the traveler — among other things — “affirm[s] that vaccination is contrary to my religious beliefs, and that my objections to this vaccination are not based solely on grounds of personal philosophy, preference, or inconvenience.”

For the “Request for Vaccine Waiver for Medical Reasons and HIPAA Waiver” — this is straight forward, asking the traveler to provide documentation of his/ her medical condition.

It noted that the Health Department may need to confirm the health information. It also asks the traveler to complete the “the Medical Records Request and HIPAA Authorization to Disclose Medical Records” from the traveler’s medical provider and to be received by DoH.

Samoa News notes that HIPAA (Health Insurance Portability and Accountability Act) is the federal law that protects sensitive patient health information from being disclosed without the patient's consent or knowledge.

Some public comments received by Samoa News indicate that ASG has taken the right direction in its waiver for medical reasons, as this is the same practice as other states.

The waiver request forms are available on the ASG website (www.americansamoa.gov) for download.