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Federal forms, ICRs, and supporting documents

OMB control number

Repatriation/Emergency Medical and Dietary Assistance Loan Application

OMB 1405-0150 · STATE/AFA.

OMB 1405-0150

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.

The latest form for Repatriation/Emergency Medical and Dietary Assistance Loan Application expires 2027-06-30 and can be found here.

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OMB Details

Repatriation/Emergency Medical and Dietary Assistance Loan Application

Federal Enterprise Architecture: International Affairs and Commerce - Foreign Affairs

Form DS-3072REPATRIATION / EMERGENCY MEDICAL AND DIETARY ASSISTANCE LOAN APPLICATIONFillable PrintableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.