OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Repatriation/Emergency Medical and Dietary Assistance Loan Application

ICR 201706-1405-005 · 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
DS-3072 Legal Authorities.doc Supplementary Document Uploaded 2017-06-30 Available
Final - 1405-0150 Supporting Statement.docx Supporting Statement A Uploaded 2017-06-30 Available
IC Document Collections
IC IDCollectionTypeStatusForm
15037 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction Modified
ICR Details
1405-0150 201706-1405-005
Historical Active 201504-1405-002
STATE/AFA
Repatriation/Emergency Medical and Dietary Assistance Loan Application
Extension without change of a currently approved collection   No
Regular
Approved without change 07/31/2017
Retrieve Notice of Action (NOA) 06/30/2017
  Inventory as of this Action Requested Previously Approved
07/31/2020 36 Months From Approved 07/31/2017
1,459 0 1,446
486 0 482
38,830 0 38,256
The DS-3072 is an application for an emergency loan for a destitute U.S. citizen and/or dependent to return to the United States, an application for a destitute U.S. citizen abroad to receive emergency medical and dietary assistance and an application for a U.S. citizen and/or dependent and a third country or host country national 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
  82 FR 8647 01/27/2017
82 FR 29973 06/30/2017
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 1,459 1,446 0 13 0 0
Annual Time Burden (Hours) 486 482 0 4 0 0
Annual Cost Burden (Dollars) 38,830 38,256 0 574 0 0
Yes
Miscellaneous Actions
No
The number of respondents varies from year to year depending on the number of citizens in need. Major events that occur during any fiscal year can drastically enlarge the average number of responses received across all U.S. posts abroad. The higher burden hour numbers correspond to an increase in respondents.
$47,228
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.
06/30/2017