Repatriation/Emergency Medical and Dietary Assistance Loan Application

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application	Form and Instruction	Modified	Repair queued
DS-3072 Legal Authorities.doc	Supplementary Document	Uploaded 2017-06-30	Available
Final - 1405-0150 Supporting Statement.docx	Supporting Statement A	Uploaded 2017-06-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
15037	Repatriation/Emergency Medical and Dietary Assistance Loan Application	Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0150	ICR Reference No: 201706-1405-005
Status: Historical Active	Previous ICR Reference No: 201504-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Repatriation/Emergency Medical and Dietary Assistance Loan Application
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/31/2017
	Date Received in OIRA: 06/30/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	36 Months From Approved	07/31/2017
Responses	1,459	0	1,446
Time Burden (Hours)	486	0	482
Cost Burden (Dollars)	38,830	0	38,256

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Abstract: 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.

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Authorizing Statute(s): US Code: 22 USC 2670 Name of Law: Responsibility of Secretary of State
   US Code: 22 USC 2671 Name of Law: Emergency expenditures
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 8647	01/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 29973	06/30/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Repatriation/Emergency Medical and Dietary Assistance Loan Application	DS-3072	Repatriation/Emergency Medical and Dietary Assistance Loan Application

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ICR Summary of Burden

table that charts list of burden

	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	1,459	1,446	0	13	0	0
Annual Time Burden (Hours)	486	482	0	4	0	0
Annual Cost Burden (Dollars)	38,830	38,256	0	574	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The number of respondents varies from year to year depending on the number of citizens in need. Major events that occur during any fiscal year can drastically enlarge the average number of responses received across all U.S. posts abroad. The higher burden hour numbers correspond to an increase in respondents.

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Annual Cost to Federal Government: $47,228

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/30/2017

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