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Federal forms, ICRs, and supporting documents

Information Collection Request

Repatriation/Emergency Medical and Dietary Assistance Loan Application

ICR 202507-1405-001 · OMB 1405-0150 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction New Repair queued
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction Unchanged Repair queued
MS Forms DS-3072 Screenshots.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-07-01 Repair queued
Justification for Non-substantive change.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-06-13 Repair queued
Privacy Act Statement Changes-easy to read.docx Supplementary Document Uploaded 2024-04-15 Repair queued
2024 04 03 856 am Answers to OIRA 2020 Questions DS 3072 Supporting Statement CLEAN NO COMMENTS.docx Supplementary Document Uploaded 2024-04-15 Repair queued
DS-3072 Legal Authorities.doc Supplementary Document Uploaded 2017-06-30 Repair queued
2024 04 03 901 AM DS-3072 Supporting Statement 2020 doc Revised Clean Version NO L COMMENTS OR EDITS.docx Supporting Statement A Uploaded 2024-04-15 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
276052 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction New
15037 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction Unchanged
ICR Details
1405-0150 202507-1405-001
Received in OIRA 202406-1405-004
STATE/AFA
Repatriation/Emergency Medical and Dietary Assistance Loan Application
No material or nonsubstantive change to a currently approved collection   No
Regular 07/01/2025
  Requested Previously Approved
06/30/2027 06/30/2027
2,918 1,459
972 486
77,660 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 2670 Name of Law: Responsibility of Secretary of State
   US Code: 22 USC 2671 Name of Law: Emergency expenditures
  
None
Not associated with rulemaking
  85 FR 28691 05/13/2020
85 FR 46207 07/31/2020
No
  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 2,918 1,459 0 0 1,459 0
Annual Time Burden (Hours) 972 486 0 0 486 0
Annual Cost Burden (Dollars) 77,660 38,830 0 0 38,830 0
No
No
$47,228
No
    Yes
    Yes
No
No
No
No
Thales Dus 202 485-6725
  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.
07/01/2025