Importation of Human Remains into the U.S. for Burial, Entombment, or Cremation

Steps to take for importing human remains

When a U.S. citizen or lawful permanent resident dies outside the United States, the deceased person's next of kin or legal representative should:

First, notify U.S. consular officials at the Department of State

• Consular personnel are available 24 hours a day, 7 days a week, to provide assistance to U.S. citizens for overseas emergencies, including death of a U.S. citizen abroad.
• If the deceased person's next of kin or legal representative is in a different country from that of the deceased person, they can call the Department of State's Office of Overseas Citizens Services in Washington, DC, from 8 am to 5 pm Eastern time, Monday through Friday, at 888-407-4747 (toll-free) or 202-501-4444.
• For emergency assistance after working hours or on weekends and holidays, call the Department of State switchboard at 202-647-4000 and ask to speak with the Overseas Citizens Services duty officer.
• In addition, the U.S. embassy or consulate in or closest to the country where the U.S. citizen or lawful permanent resident died may provide assistance.

Next, work with consular officials to obtain:

• Country export clearance requirements where death occurred (such as death certificate, autopsy report*)
• U.S. import documents (such as death certificate, Consular Mortuary Certificate, Affidavit of Foreign Funeral Director and Transit Permit, CDC import permit in the case of an infectious disease)
• Packaging (such as urn for cremated remains, casket, body transfer case)
• Assistance with transportation (such as local transportation, international airline)

*While CDC does not require an autopsy before the remains of a person who died overseas are returned to the United States, depending on the circumstances surrounding the death, some countries may require an autopsy before exportation.

There likely will need to be an official identification of the body and official documents issued by the consular office.

Requirements for importation into the U.S.

Death certificate

Except for cremated or embalmed remains, human remains intended for final resting after entry into the United States must be accompanied by a death certificate stating the cause of death. A death certificate is an official government document that certifies a death has occurred and provides identifying information about the deceased, including name, age, and sex, as well as the time, place, and cause of death.

If the official death certificate is not written in English, then it must include an English language translation of the official government document. A person licensed to perform acts in legal affairs in the country where the death occurred, such as a notary, must attest to the document's authenticity.

If a death certificate is not available, the U.S. embassy or consulate should provide the Consular Mortuary Certificate, the Affidavit of Foreign Funeral Director, and the Transit Permit. The Consular Mortuary Certificate or the importer certification statement should confirm the cause of death was not due to an infectious disease. Alternatively, an importer certification statement can be provided; the importer certification statement must confirm that the human remains are not known to contain or state why the human remains are not reasonably suspected of containing an infectious biological agent.

Leak-proof containers

All non-cremated remains must be fully contained within a leak-proof container that is packaged and shipped in accordance with all applicable legal requirements. This requirement does not apply to cremated remains, clean and dry bones, human hair, teeth, fingernails, or toenails.

The requirement for leak-proof containers is based on medical infection prevention and control practices (i.e., Standard Precautions) to prevent exposure to blood and other body fluids. Microbes (germs) that can cause disease, such as human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus, could be present in the blood or other body fluids of a deceased person even if the stated cause of death was not an infectious disease. This requirement is intended to protect the public as well as federal, airline, and airport employees from potential exposure to blood and other body fluids during transportation, inspection, or storage of human remains.

This guidance does not apply to these items:

• patient specimens or diagnostic specimens (see the Import Permit Program)
• tissues or organs legally imported into the United States for the purpose of transplantation that are regulated by the Food and Drug Administration
• all other infectious biological agents, infectious substances and vectors covered by 42 CFR §71.54
• passengers or crew members who die during travel

Permits

There are no permit requirements for importation of human remains consisting entirely of

• Clean, dry bones or bone fragments; human hair; teeth; fingernails or toenails; or
• Human remains that have already been fully cremated or embalmed before importation.

The following remains fall under the authority of 42 CFR §71.54 Import regulations for infectious biological agents, infectious substances, and vectors and may require a CDC import permit:

• Human remains imported for any purpose other than burial, entombment or cremation (such as research, training, education, ceremonial, collectible)
• The remains of a person who died from an infectious disease (unless embalmed)

Permits for the importation of the remains of a person known or suspected to have died from an infectious disease that have not been embalmed or cremated may be obtained by calling the CDC Emergency Operations Center at 770-488-7100 or emailing cdcimports@cdc.gov.

CDC’s authority and guidance

The Department of Health and Human Services/CDC has been tasked by Congress, through the Public Health Service Act, to publish regulations that ensure that human remains imported into the United States for final resting do not contain an infectious biological agent that could threaten public health. This authority applies to the whole body or body portion of a deceased human being, including internal or external body parts, being consigned directly to a licensed mortuary, cemetery, or crematory for immediate and final preparation before final resting. The public health requirements for importing human remains can be found under 42 CFR §71.55, "Control of Communicable Diseases; Importation of Human Remains."

Definition for terms used in this guidance

Cremated remains

The ashes that remain after a human body is burned.

Death certificate

An official government document that certifies a death has occurred and provides identifying information about the deceased, including name, age, and sex, as well as the time, place, and cause of death.

Human remains

The body (or part of the body) of a dead person, except:

• Clean, dry bones or bone fragments; human hair; teeth; fingernails or toenails; or
• Cremated remains; or
• Human cells, tissues, or cellular or tissue-based products intended for implantation, transplantation, infusion, or transfer into another person.

Importer

Any person bringing (or attempting to bring) human remains into the United States.

Infectious biological agent

A microbe (germ), including bacteria, viruses, fungi, and parasites, or prion that is capable of causing disease in humans

Infectious substance

Any material that is known or reasonably expected to contain an infectious biological agent

Leak-proof container

A container that is puncture-resistant and sealed in such a manner as to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping, and may include:

• A double-layered plastic, puncture-resistant body bag (i.e., two sealed body bags, one inside the other);
• A casket with an interior lining certified by the manufacturer to be leak-proof and puncture-resistant; or
• A sealed metal body-transfer case.