Information Collection

Evacuee Manifest and Promissory Note

IC 206882 under ICR 201906-1405-003 · OMB 1405-0211.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0211 can be found here:

Documents and Forms

Document Name Document Type
Form DS-5528 Evacuee Manifest and Promissory Note Form and Instruction
DS-5528 Evacuee Manifest and Promissory Note DS-5528 (Fillable).pdf Form and Instruction
DS-5528 Evacuee Manifest and Promissory Note DS-5528 - arabic translation.docx Form
DS-5528 EVACUEE MANIFEST AND PROMISSORY NOTE ds5528.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evacuee Manifest and Promissory Note	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 Part 71 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-5528	Evacuee Manifest and Promissory Note	DS-5528 (Fillable).pdf	Yes	No	Fillable Printable
Form	DS-5528	Evacuee Manifest and Promissory Note	DS-5528 - arabic translation.docx	Yes	Yes	Paper Only
Form and Instruction	DS-5528	EVACUEE MANIFEST AND PROMISSORY NOTE	ds5528.pdf	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: Overseas Citizens Services Records - State 05	FR Citation: 73 FR 24342

Number of Respondents: 525	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	525	525
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

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.