OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

U.S. Repatriation Program Forms

ICR 202602-0970-008 · OMB 0970-0474 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 Repatriation Training and Technical Assistance Request Form Form Unchanged Repair queued
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support - Traditional Chinese Form and Instruction Unchanged Repair queued
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support - Spanish Form and Instruction Unchanged Repair queued
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support - Simplified Chinese Form and Instruction Unchanged Available
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support - Russian Form and Instruction Unchanged Repair queued
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support - French Form and Instruction Unchanged Repair queued
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support - Arabic Form and Instruction Unchanged Available
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction Unchanged Repair queued
Form RR-07 Temporary Assistance Extension Request - Traditional Chinese Form and Instruction Unchanged Repair queued
Form RR-07 Temporary Assistance Extension Request - Spanish Form and Instruction Unchanged Repair queued
Form RR-07 Temporary Assistance Extension Request - Simplified Chinese Form and Instruction Unchanged Available
Form RR-07 Temporary Assistance Extension Request - Russian Form and Instruction Unchanged Available
Form RR-07 Temporary Assistance Extension Request - French Form and Instruction Unchanged Repair queued
Form RR-07 Temporary Assistance Extension Request - Arabic Form and Instruction Unchanged Repair queued
Form RR-07 Temporary Assistance Extension Request Form and Instruction Unchanged Repair queued
Form RR-06 Refusal of Temporary Assistance - Traditional Chinese Form and Instruction Unchanged Available
Form RR-06 Refusal of Temporary Assistance - Spanish Form and Instruction Unchanged Available
Form RR-06 Refusal of Temporary Assistance - Simplified Chinese Form and Instruction Unchanged Available
Form RR-06 Refusal of Temporary Assistance - Russian Form and Instruction Unchanged Available
Form RR-06 Refusal of Temporary Assistance - French Form and Instruction Unchanged Available
Form RR-06 Refusal of Temporary Assistance - Arabic Form and Instruction Unchanged Available
Form RR-06 Refusal of Temporary Assistance Form and Instruction Unchanged Available
Form RR-05 Repatriation Repayment and Privacy Agreement Form and Instruction Unchanged Available
Form RR-04 Routine Repatriation Reimbursement Request - Traditional Chinese Form and Instruction Unchanged Available
Form RR-04 Routine Repatriation Reimbursement Request - Spanish Form and Instruction Unchanged Available
Form RR-04 Routine Repatriation Reimbursement Request - Simplified Chinese Form and Instruction Unchanged Available
Form RR-04 Routine Repatriation Reimbursement Request - Russian Form and Instruction Unchanged Available
Form RR-04 Routine Repatriation Reimbursement Request - French Form and Instruction Unchanged Available
Form RR-04 Routine Repatriation Reimbursement Request - Arabic Form and Instruction Unchanged Available
Form RR-04 Routine Repatriation Reimbursement Request Form and Instruction Unchanged Available
Form RR-03 Loan Waiver and Deferral Application - Traditional Chinese Form and Instruction Unchanged Available
Form RR-03 Loan Waiver and Deferral Application - Spanish Form and Instruction Unchanged Available
Form RR-03 Loan Waiver and Deferral Application - Simplified Chinese Form and Instruction Unchanged Available
Form RR-03 Loan Waiver and Deferral Application - Russian Form and Instruction Unchanged Available
Form RR-03 Loan Waiver and Deferral Application - French Form and Instruction Unchanged Available
Form RR-03 Loan Waiver and Deferral Application - Arabic Form and Instruction Unchanged Available
Form RR-03 Loan Waiver and Deferral Application Form and Instruction Unchanged Available
Form RR-02 Emergency Repatriation Reimbursement Request - Traditional Chinese Form and Instruction Unchanged Available
Form RR-02 Emergency Repatriation Reimbursement Request - Spanish Form and Instruction Unchanged Available
Form RR-02 Emergency Repatriation Reimbursement Request - Simplified Chinese Form and Instruction Unchanged Available
Form RR-02 Emergency Repatriation Reimbursement Request - Russian Form and Instruction Unchanged Available
Form RR-02 Emergency Repatriation Reimbursement Request - French Form and Instruction Unchanged Available
Form RR-02 Emergency Repatriation Reimbursement Request - Arabic Form and Instruction Unchanged Available
Form RR-02 Emergency Repatriation Reimbursement Request Form and Instruction Unchanged Available
Form RR-01 Emergency Repatriation Eligibility Application Form and Instruction Unchanged Available
NonSub Change Request - Correct SSA for 0970-0474.docx Justification for No Material/Nonsubstantive Change Uploaded 2026-02-17 Repair queued
NonSub Change Request - Compliance Repat - 10Feb2025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-02-10 Repair queued
Supporting Statement A - OHSEPR Repat Forms PTE TTA_0970-0474_CLEAN_Nov152023_Passback update Jan 2024_EO Up.docx Supporting Statement A Uploaded 2026-02-17 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
263518 Repatriation Post-Training Survey Other-Survey Unchanged
263517 Repatriation Training and Technical Assistance Request Form Form UnchangedRepatriation Training and Technical Assistance Request Form
263517 Repatriation Training and Technical Assistance Request Form Form Unchanged
263516 Repatriation State Contact List Other-Contact List Unchanged
263515 Planning, Training, and Exercise – Budget and Budget Narrative Other-Narrative Unchanged
263514 Planning, Training, and Exercise – Annual Workplan Other-Workplan Unchanged
263513 Planning, Training, and Exercise – Project Narrative Other-Narrative Unchanged
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction UnchangedEmergency Repatriation Request for Cost Approval and Federal Support - Traditional Chinese
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction UnchangedEmergency Repatriation Request for Cost Approval and Federal Support - Spanish
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction UnchangedEmergency Repatriation Request for Cost Approval and Federal Support - Simplified Chinese
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction UnchangedEmergency Repatriation Request for Cost Approval and Federal Support - Russian
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction UnchangedEmergency Repatriation Request for Cost Approval and Federal Support - French
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction UnchangedEmergency Repatriation Request for Cost Approval and Federal Support - Arabic
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction UnchangedEmergency Repatriation Request for Cost Approval and Federal Support
218660 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction Unchanged
218659 Temporary Assistance Extension Request Form and Instruction UnchangedTemporary Assistance Extension Request - Traditional Chinese
218659 Temporary Assistance Extension Request Form and Instruction UnchangedTemporary Assistance Extension Request - Spanish
218659 Temporary Assistance Extension Request Form and Instruction UnchangedTemporary Assistance Extension Request - Simplified Chinese
218659 Temporary Assistance Extension Request Form and Instruction UnchangedTemporary Assistance Extension Request - Russian
218659 Temporary Assistance Extension Request Form and Instruction UnchangedTemporary Assistance Extension Request - French
218659 Temporary Assistance Extension Request Form and Instruction UnchangedTemporary Assistance Extension Request - Arabic
218659 Temporary Assistance Extension Request Form and Instruction UnchangedTemporary Assistance Extension Request
218659 Temporary Assistance Extension Request Form and Instruction Unchanged
218658 Refusal of Temporary Assistance Form and Instruction UnchangedRefusal of Temporary Assistance - Traditional Chinese
218658 Refusal of Temporary Assistance Form and Instruction UnchangedRefusal of Temporary Assistance - Spanish
218658 Refusal of Temporary Assistance Form and Instruction UnchangedRefusal of Temporary Assistance - Simplified Chinese
218658 Refusal of Temporary Assistance Form and Instruction UnchangedRefusal of Temporary Assistance - Russian
218658 Refusal of Temporary Assistance Form and Instruction UnchangedRefusal of Temporary Assistance - French
218658 Refusal of Temporary Assistance Form and Instruction UnchangedRefusal of Temporary Assistance - Arabic
218658 Refusal of Temporary Assistance Form and Instruction UnchangedRefusal of Temporary Assistance
218658 Refusal of Temporary Assistance Form and Instruction Unchanged
218657 Repatriation Repayment and Privacy Agreement Form and Instruction UnchangedRepatriation Repayment and Privacy Agreement
218657 Repatriation Repayment and Privacy Agreement Form and Instruction Unchanged
218656 Routine Repatriation Reimbursement Request Form and Instruction UnchangedRoutine Repatriation Reimbursement Request - Traditional Chinese
218656 Routine Repatriation Reimbursement Request Form and Instruction UnchangedRoutine Repatriation Reimbursement Request - Spanish
218656 Routine Repatriation Reimbursement Request Form and Instruction UnchangedRoutine Repatriation Reimbursement Request - Simplified Chinese
218656 Routine Repatriation Reimbursement Request Form and Instruction UnchangedRoutine Repatriation Reimbursement Request - Russian
218656 Routine Repatriation Reimbursement Request Form and Instruction UnchangedRoutine Repatriation Reimbursement Request - French
218656 Routine Repatriation Reimbursement Request Form and Instruction UnchangedRoutine Repatriation Reimbursement Request - Arabic
218656 Routine Repatriation Reimbursement Request Form and Instruction UnchangedRoutine Repatriation Reimbursement Request
218656 Routine Repatriation Reimbursement Request Form and Instruction Unchanged
218655 Loan Waiver and Deferral Application Form and Instruction UnchangedLoan Waiver and Deferral Application - Traditional Chinese
218655 Loan Waiver and Deferral Application Form and Instruction UnchangedLoan Waiver and Deferral Application - Spanish
218655 Loan Waiver and Deferral Application Form and Instruction UnchangedLoan Waiver and Deferral Application - Simplified Chinese
218655 Loan Waiver and Deferral Application Form and Instruction UnchangedLoan Waiver and Deferral Application - Russian
218655 Loan Waiver and Deferral Application Form and Instruction UnchangedLoan Waiver and Deferral Application - French
218655 Loan Waiver and Deferral Application Form and Instruction UnchangedLoan Waiver and Deferral Application - Arabic
218655 Loan Waiver and Deferral Application Form and Instruction UnchangedLoan Waiver and Deferral Application
218655 Loan Waiver and Deferral Application Form and Instruction Unchanged
218654 Emergency Repatriation Reimbursement Request Form and Instruction UnchangedEmergency Repatriation Reimbursement Request - Traditional Chinese
218654 Emergency Repatriation Reimbursement Request Form and Instruction UnchangedEmergency Repatriation Reimbursement Request - Spanish
218654 Emergency Repatriation Reimbursement Request Form and Instruction UnchangedEmergency Repatriation Reimbursement Request - Simplified Chinese
218654 Emergency Repatriation Reimbursement Request Form and Instruction UnchangedEmergency Repatriation Reimbursement Request - Russian
218654 Emergency Repatriation Reimbursement Request Form and Instruction UnchangedEmergency Repatriation Reimbursement Request - French
218654 Emergency Repatriation Reimbursement Request Form and Instruction UnchangedEmergency Repatriation Reimbursement Request - Arabic
218654 Emergency Repatriation Reimbursement Request Form and Instruction UnchangedEmergency Repatriation Reimbursement Request
218654 Emergency Repatriation Reimbursement Request Form and Instruction Unchanged
218653 Emergency Repatriation Eligibility Application Form and Instruction UnchangedEmergency Repatriation Eligibility Application
218653 Emergency Repatriation Eligibility Application Form and Instruction Unchanged
ICR Details
0970-0474 202602-0970-008
Active 202502-0970-024
HHS/ACF OHSEPR
U.S. Repatriation Program Forms
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/19/2026
Retrieve Notice of Action (NOA) 02/17/2026
  Inventory as of this Action Requested Previously Approved
01/31/2027 01/31/2027 01/31/2027
5,140 0 5,140
1,470 0 1,470
0 0 0
The U.S. Repatriation Program (Program) is authorized by Section 1113 of the Social Security Act (42 U.S.C. § 1313) and the assistance provided to mentally ill repatriates found under 24 U.S.C. §§ 321 - 329. This Program also provides services for emergency repatriations which are authorized under Section 1113 and by the extension of the Executive Order (E.O.) precedent, E.O. 12656 (53 CFR 47491). Program regulations are in 45 CFR 211 & 212. The current collection includes eight forms with translations in six languages. The information collected through these forms allows the Office of Human Services Emergency Preparedness and Response (OHSEPR) to fulfill its statutory responsibilities to provide temporary assistance to repatriates. The Program also provides training and technical assistance to states and territories for routine and emergency repatriation. Additionally, OHSEPR provides funding to states for emergency repatriation planning, training, and exercises. In 2025, ACF submitted updates to forms under this collection in response to new Executive Orders. Through that process, OMB requested minor edits to the SSA to align with the updates to the form. Through that revision process the incorrect SSA was inadvertently updated and sent for upload. ACF would like to replace the currently uploaded SSA with the correct version. The correct version matches the data entered in ROCIS in terms of burden estimates and forms approved.
US Code: 24 USC 321-329 Name of Law: Hospitals and Asylums
   US Code: 42 USC 1313 Name of Law: Social Security Act
   EO: EO 12656 Name/Subject of EO: Assignment of Emergency Preparedness Responsibilities
  
None
Not associated with rulemaking
  88 FR 15728 03/14/2023
88 FR 81087 11/21/2023
No
14
IC Title Form No. Form Name
Emergency Repatriation Eligibility Application RR-01 Emergency Repatriation Eligibility Application
Emergency Repatriation Reimbursement Request RR-02, RR-02, RR-02, RR-02, RR-02, RR-02, RR-02 Emergency Repatriation Reimbursement Request ,   Emergency Repatriation Reimbursement Request - Arabic ,   Emergency Repatriation Reimbursement Request - French ,   Emergency Repatriation Reimbursement Request - Russian ,   Emergency Repatriation Reimbursement Request - Simplified Chinese ,   Emergency Repatriation Reimbursement Request - Spanish ,   Emergency Repatriation Reimbursement Request - Traditional Chinese
Emergency Repatriation Request for Cost Approval and Federal Support RR-08, RR-08, RR-08, RR-08, RR-08, RR-08, RR-08 Emergency Repatriation Request for Cost Approval and Federal Support ,   Emergency Repatriation Request for Cost Approval and Federal Support - Arabic ,   Emergency Repatriation Request for Cost Approval and Federal Support - French ,   Emergency Repatriation Request for Cost Approval and Federal Support - Russian ,   Emergency Repatriation Request for Cost Approval and Federal Support - Simplified Chinese ,   Emergency Repatriation Request for Cost Approval and Federal Support - Spanish ,   Emergency Repatriation Request for Cost Approval and Federal Support - Traditional Chinese
Loan Waiver and Deferral Application RR-03, RR-03, RR-03, RR-03, RR-03, RR-03, RR-03 Loan Waiver and Deferral Application ,   Loan Waiver and Deferral Application - Arabic ,   Loan Waiver and Deferral Application - French ,   Loan Waiver and Deferral Application - Russian ,   Loan Waiver and Deferral Application - Simplified Chinese ,   Loan Waiver and Deferral Application - Spanish ,   Loan Waiver and Deferral Application - Traditional Chinese
Planning, Training, and Exercise – Annual Workplan
Planning, Training, and Exercise – Budget and Budget Narrative
Planning, Training, and Exercise – Project Narrative
Refusal of Temporary Assistance RR-06, RR-06, RR-06, RR-06, RR-06, RR-06, RR-06 Refusal of Temporary Assistance ,   Refusal of Temporary Assistance - Arabic ,   Refusal of Temporary Assistance - French ,   Refusal of Temporary Assistance - Russian ,   Refusal of Temporary Assistance - Simplified Chinese ,   Refusal of Temporary Assistance - Spanish ,   Refusal of Temporary Assistance - Traditional Chinese
Repatriation Post-Training Survey
Repatriation Repayment and Privacy Agreement RR-05 Repatriation Repayment and Privacy Agreement
Repatriation State Contact List
Repatriation Training and Technical Assistance Request Form 1 Repatriation Training and Technical Assistance Request Form
Routine Repatriation Reimbursement Request RR-04, RR-04, RR-04, RR-04, RR-04, RR-04, RR-04 Routine Repatriation Reimbursement Request ,   Routine Repatriation Reimbursement Request - Arabic ,   Routine Repatriation Reimbursement Request - French ,   Routine Repatriation Reimbursement Request - Russian ,   Routine Repatriation Reimbursement Request - Simplified Chinese ,   Routine Repatriation Reimbursement Request - Spanish ,   Routine Repatriation Reimbursement Request - Traditional Chinese
Temporary Assistance Extension Request RR-07, RR-07, RR-07, RR-07, RR-07, RR-07, RR-07 Temporary Assistance Extension Request ,   Temporary Assistance Extension Request - Arabic ,   Temporary Assistance Extension Request - French ,   Temporary Assistance Extension Request - Russian ,   Temporary Assistance Extension Request - Simplified Chinese ,   Temporary Assistance Extension Request - Spanish ,   Temporary Assistance Extension Request - Traditional Chinese
  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 5,140 5,140 0 0 0 0
Annual Time Burden (Hours) 1,470 1,470 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$212,612
No
    Yes
    Yes
No
No
No
No
Molly Buck 202 205-4724 [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.
02/17/2026