Importation of Human Remains into the United States for Burial, Entombment, or Cremation
CDC requirements for importing human remains depend on the purpose of importation, whether the body has been embalmed or cremated, and if the person died from a quarantinable communicable disease.
When a US citizen or lawful permanent resident dies outside the United States, the deceased person’s next of kin or legal representative should:
- Notify US consular officials at the Department of State
- Consular personnel are available 24 hours a day, 7 days a week, to provide assistance to US citizens for overseas emergencies.
- If the deceased person’s next of kin or legal representative is in a different country from that of the deceased person, they should 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 US embassy or consulateexternal icon closest to or in the country where the US citizen or lawful permanent resident died may provide assistance.
- Work with consular officials to obtain:
- Country export clearance requirements where death occurred (such as death certificate, autopsy report*)
- US import documents (such as death certificate, Consular Mortuary Certificate, Affidavit of Foreign Funeral Director and Transit Permit, CDC import permit in the case of a quarantinable communicable disease)
- Packaging (such as urn for cremation, 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.
Authority and Guidance
CDC’s regulatory authority under 42 CFR §71.55external icon Importation of Human Remains, governs the importation of the remains of a person intended for burial, entombment, or cremation (“final resting”). 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. This provision explains that if imported remains will undergo a medical examination or autopsy, the remains must be consigned directly to an entity authorized to perform such functions under the laws of the applicable jurisdiction prior to final resting.
42 CFR §71.55 also indicates that certain human remains may require a permit under 42 CFR §71.54 Import regulations for infectious biological agents, infectious substances, and vectors. Human remains imported for any purpose other than final resting (such as research, training, education, ceremonial, collectible), or those remains of a person who died from a quarantinable communicable disease, unless embalmed, fall under the authority of 42 CFR §71.54external icon, and may require a CDC import permit.
There are no requirements for importation of human remains consisting entirely of
- Clean, dry bones or bone fragments; human hair; teeth; fingernails or toenails; or
- A deceased human body and portions thereof that have already been fully cremated before importation.
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 (at a minimum) name, age, and sex. The document must also certify the time, place, and cause of death (if known).
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. In lieu of a death certificate, a copy of the Consular Mortuary Certificate and the Affidavit of Foreign Funeral Director and Transit Permit shall together constitute acceptable identification of human remains. If a death certificate is not available in time for returning the remains, the US embassy or consulateexternal icon should provide a consular mortuary certificate stating whether the person died from a disease classified as quarantinable in the United States.
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. Germs that can cause disease could be present in the blood or other body fluids of a deceased person even if the stated cause of death is not a contagious disease. Such germs include human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and other germs that can be present in body fluids.
The requirement for leak-proof containers is based on medical Standard Precautions to prevent exposure to infectious diseases carried in the blood and other body fluids. 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 addressed under other US federal regulations:
- patient specimens or diagnostic specimens
- human tissue or products intended for research, education, training, or other purposes (such as ceremonial or collectible)
- 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 §71.54external icon
- passengers or crew members who die during travel
Cremated remains (ashes)—The residual matter after human remains are completely reduced to ash by intense heat. For the purposes of this SOP, cremated remains are considered to be noninfectious and may enter the United States without a death certificate or other documentation, regardless of the cause of death.
Death certificate—An official government document that certifies that a death has occurred and provides identifying information about the deceased, including (at a minimum) name, age, and sex. The document must also certify the time, place, and cause of death (if known). If the official government document 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. In lieu of a death certificate, a copy of the Consular Mortuary Certificate and the Affidavit of Foreign Funeral Director and Transit Permit shall together constitute acceptable identification of human remains.
Human remains means a deceased human body or any portion of a deceased human body, except:
- Clean, dry bones or bone fragments; human hair; teeth; fingernails or toenails; or
- A deceased human body and portions thereof that have already been fully cremated before import; or
- Human cells, tissues, or cellular or tissue-based products intended for implantation, transplantation, infusion, or transfer into a human recipient.
Importer means any person importing or attempting to import an item regulated under this subpart.
Leak-proof container means 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, such as
- 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.
Quarantinable communicable diseases—Certain communicable diseases specified by Presidential Executive Order for which CDC has the authority to issue federal public health orders. Quarantinable communicable diseases currently include cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named), severe acute respiratory syndromes, and influenza caused by novel or re-emergent influenza viruses, that are causing, or have the potential to cause a pandemic
Standard Precautions (formerly referred to as Universal Precautions)—An approach to infection control in which all human blood and certain human body fluids are considered to be infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and other bloodborne pathogens, and are handled accordingly.