OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Repatriation/Emergency Medical and Dietary Assistance Loan Application

ICR 201504-1405-002 · OMB 1405-0150 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction Modified Repair queued
Legal Authorities (4-2015).docx Supplementary Document Uploaded 2015-04-14 Available
Supporting Statement (5-2015 rev).docx Supporting Statement A Uploaded 2015-05-27 Available
IC Document Collections
IC IDCollectionTypeStatusForm
15037 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction Modified
ICR Details
1405-0150 201504-1405-002
Historical Active 201305-1405-001
STATE/AFA
Repatriation/Emergency Medical and Dietary Assistance Loan Application
Extension without change of a currently approved collection   No
Regular
Approved with change 06/01/2015
Retrieve Notice of Action (NOA) 04/14/2015
Approved for two years only due to lack of GPEA compliance. This form cannot be submitted online.
  Inventory as of this Action Requested Previously Approved
06/30/2017 36 Months From Approved 06/30/2015
1,446 0 1,357
482 0 452
38,256 0 86,750
The DS-3072 is an application for an emergency loan for a destitute U.S. citizen and/or eligible family member to return to the United States, an application for a destitute U.S. citizen and/or eligible family member abroad to receive emergency medical and dietary assistance, and an application for a U.S. citizen and/or and/or eligible family member to receive a loan to assist in his or her repatriation to the United States, and/or to provide them with the funds needed to address their emergency medical and/or dietary needs.
US Code: 22 USC 2670 Name of Law: Responsibility of Secretary of State
   US Code: 22 USC 2671 Name of Law: Emergency expenditures
  
None
Not associated with rulemaking
  80 FR 2770 01/20/2015
80 FR 20061 04/14/2015
No
  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 1,446 1,357 0 0 89 0
Annual Time Burden (Hours) 482 452 0 0 30 0
Annual Cost Burden (Dollars) 38,256 86,750 0 0 -48,494 0
No
No
Burden changes are due to an increase in respondents and a more accurate estimation of submission costs for this collection.
$39,633
No
No
No
No
No
Uncollected
Derek Rivers 202 736-9082 [email protected]
  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.
04/14/2015