Information Collection

Evacuee Manifest and Promissory Note

IC 206882 under ICR 201906-1405-003 · OMB 1405-0211.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0211 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-5528 Evacuee Manifest and Promissory Note	Form and Instruction
DS-5528 Evacuee Manifest and Promissory Note DS-5528 (Fillable).pdf	Form and Instruction
DS-5528 Evacuee Manifest and Promissory Note DS-5528 - arabic translation.docx	Form
DS-5528 EVACUEE MANIFEST AND PROMISSORY NOTE ds5528.pdf	Form and Instruction

IC Title:

Evacuee Manifest and Promissory Note

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR Part 71 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-5528	Evacuee Manifest and Promissory Note	DS-5528 (Fillable).pdf	Yes	No	Fillable Printable
Form	DS-5528	Evacuee Manifest and Promissory Note	DS-5528 - arabic translation.docx	Yes	Yes	Paper Only
Form and Instruction	DS-5528	EVACUEE MANIFEST AND PROMISSORY NOTE	ds5528.pdf	Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title: Overseas Citizens Services Records - State 05

FR Citation: 73 FR 24342

Number of Respondents: 525

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	525	525
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.