OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Evacuee Manifest and Promissory Note

OMB 1405-0211 · STATE/AFA.

OMB 1405-0211

The DS 5528, Evacuee Manifest and Promissory Note, is used to document the evacuation of persons from abroad when their lives are endangered by war, civil unrest, or natural disaster; document issuance of a crisis evacuation loan; to obtain a Privacy Act waiver to share information about the welfare of a citizen or lawful permanent resident with designated persons; and to facilitate debt collection.

The latest form for Evacuee Manifest and Promissory Note expires 2027-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form and Instruction
Form and Instruction
Justification for No Material/Nonsubstantive Change
Justification for No Material/Nonsubstantive Change
Justification for No Material/Nonsubstantive Change
Justification for No Material/Nonsubstantive Change
Supplementary Document
Supplementary Document
Supporting Statement A
Supporting Statement A
Supplementary Document
Supplementary Document
All Historical Document Collections
 No material or nonsubstantive change to a currently approved collection 2025-09-18
Approved without change
 No material or nonsubstantive change to a currently approved collection 2024-06-13
Approved without change
 Reinstatement without change of a previously approved collection 2024-04-15
Revision of a currently approved collection 2020-07-31
Approved without change
 No material or nonsubstantive change to a currently approved collection 2019-06-26
Approved without change
 No material or nonsubstantive change to a currently approved collection 2018-07-11
Approved without change
 Extension without change of a currently approved collection 2017-05-12
Approved with change
 No material or nonsubstantive change to a currently approved collection 2016-02-12
Improperly submitted and continue
 No material or nonsubstantive change to a currently approved collection 2016-01-29
Improperly submitted and continue
 Revision of a currently approved collection 2016-01-28
Approved with change
 Extension without change of a currently approved collection 2015-04-14
Approved with change
 New collection (Request for a new OMB Control Number) 2013-05-14
OMB Details

Evacuee Manifest and Promissory Note

Federal Enterprise Architecture: Disaster Management - Emergency Response

Form DS-5528Evacuee Manifest and Promissory NoteFillable PrintableForm and instruction
Form DS-5528Evacuee Manifest and Promissory NotePaper OnlyForm

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