OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Repatriation/Emergency Medical and Dietary Assistance Loan Application

ICR 202007-1405-004 · OMB 1405-0150 · Received in OIRA

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.docx Supplementary Document Uploaded 2020-07-31 Repair queued
DS-3072 Supporting Statement 2020 30day doc.docx Supporting Statement A Uploaded 2020-07-31 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
15037 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction Modified
ICR Details
1405-0150 202007-1405-004
Received in OIRA 201906-1405-002
STATE/AFA
Repatriation/Emergency Medical and Dietary Assistance Loan Application
Revision of a currently approved collection   No
Regular 07/31/2020
  Requested Previously Approved
36 Months From Approved 01/31/2021
1,459 1,459
486 486
39,861 38,830
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 2671 Name of Law: Emergency expenditures
   US Code: 22 USC 2670 Name of Law: Responsibility of Secretary of State
  
None
Not associated with rulemaking
  85 FR 28691 05/13/2020
85 FR 46207 07/31/2020
Yes
  Total Request 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 1,459 0 0 0 0
Annual Time Burden (Hours) 486 486 0 0 0 0
Annual Cost Burden (Dollars) 39,861 38,830 0 1,031 0 0
No
No
$28,888
No
    Yes
    Yes
No
No
No
No
Clifton Oliphant 202 485-6020
  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.
07/31/2020