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Federal forms, ICRs, and supporting documents

Information Collection Request

U.S. REPATRIATE PROGRAM, PRIVACY ACT STATEMENT AND REPAYMENT AGREEMENT

ICR 199210-0970-001 · OMB 0970-0125 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
116022 U.S. REPATRIATE PROGRAM, PRIVACY ACT STATEMENT AND REPAYMENT AGREEMENT Form Migrated
ICR Details
0970-0125 199210-0970-001
Historical Active
HHS/ACF
U.S. REPATRIATE PROGRAM, PRIVACY ACT STATEMENT AND REPAYMENT AGREEMENT
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/18/1992
Retrieve Notice of Action (NOA) 10/02/1992
  Inventory as of this Action Requested Previously Approved
12/31/1995 12/31/1995
500 0 0
17 0 0
0 0 0
SECTION 1113 OF THE SOCIAL SECURITY ACT REQUIRES U.S. CITIZENS WHO RECEIVE REPATRIATION ASSISTANCE TO REPAY THAT ASSISTANCE TO THE FEDERA GOVERNMENT. COLLECTION GATHERS IDENTIFYING INFORMATION FROM RECIPIENT FOR DOCUMENTATION AND DEBT COLLECTION PURPOSES.
None
None
No
1
IC Title Form No. Form Name
U.S. REPATRIATE PROGRAM, PRIVACY ACT STATEMENT AND REPAYMENT AGREEMENT ACF-120
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 500 0 0 500 0 0
Annual Time Burden (Hours) 17 0 0 17 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/02/1992