Public Health
Unless a cruise ship is returning from a part of the world that has a disease outbreak, federal inspectors usually combine the public health inspection with one of the others and you won't be asked to show a proof of vaccination or a health certificate. However, if you are traveling extensively in the rural areas of Central America, South America, Africa, or Asia on a pre- or post-cruise extension, you should check out the CDC Web site information on traveling overseas. Sometimes a yellow fever or other vaccination is required. Although your travel agent can also provide information on immunization requirements, it is important for travelers to be informed and not rely on others, since the requirements are constantly changing.
Immigration
Immigration is usually the first queue you stand in when entering any country via air. If you are entering a country where you are not a citizen, the airline will give you a form to complete that includes basic information including where you will be staying. If you are embarking on a cruise, list the cruise ship as your "hotel". Give the form and show your passport to the Immigration Inspector. Most airports have separate lines for citizens, non-citizens, and diplomats and officials. Be sure to stand in the correct line, and remember that if you are not entering the U.S., you are a non-citizen!
Immigration and Customs inspectors are not just a U.S. phenomenon. If the entry point is a cruise ship port of call outside of the U.S., the immigration inspectors will come on board the ship. Sometimes passengers are anxious to go ashore and do not understand that the immigration officials are focusing on security and have a job that must be done. When the cruise director announces that "as soon as the ship clears immigration and Customs, passengers will be allowed to go ashore", he means that the inspectors are checking the ship's paperwork and may be reviewing your passport. If this is not your final port of call and you are not disembarking the ship for home, you will probably never even see the inspectors.
If you are entering the United States as a U.S. citizen, the inspector will verify your citizenship using your passport. This verification is done at any U.S. port you visit after going outside the U.S. If the ship is enroute to other international destinations, you might go through this process on the ship and immediately return your passport to the ship until the next port.
Starting in 2007, new U.S. regulations require all cruise passengers to carry a passport as a proof of citizenship on cruises that have ports of call outside the USA. In addition to cruises outside the western hemisphere, this includes cruises to the Caribbean, Canada, Mexico, and Bermuda. It is important that passenger names on passports be identical to those on the cruise and airline tickets. Otherwise, proof of name change (i.e., a marriage license) OR a valid driver's license or government issued photo ID (i.e., U.S. Military ID) must be presented.
Because of the increased security, I recommend that any American citizen who plans to travel outside the U.S. should probably get a passport as soon as possible. A passport is somewhat expensive ($97 for the first passport and $67 for a renewal) but it only has to be renewed every ten years. That's less than $10 per year. After your citizenship is verified, the inspector will direct you to the third type of inspection - customs.
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