Information Collection

Repatriation/Emergency Medical and Dietary Assistance Loan Application

IC 15037 under ICR 201706-1405-005 · OMB 1405-0150.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0150 can be found here:

Documents and Forms

Document Name Document Type
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction
DS-3072 Repatriation/Emergency Medical and Dietary Assistance Lo DS-3072 (Fillable) .pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Repatriation/Emergency Medical and Dietary Assistance Loan Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 71

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-3072	Repatriation/Emergency Medical and Dietary Assistance Loan Application	DS-3072 (Fillable) .pdf		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,459	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,459	13	1,446
Annual IC Time Burden (Hours)	486	4	482
Annual IC Cost Burden (Dollars)	38,830	574	38,256

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.