Repatriation/Emergency Medical and Dietary Assistance Loan Application

Forms and Documents

Document Name	Status
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction	Modified
DS-3072 Legal Authorities.docx Supplementary Document	2020-07-31
DS-3072 Supporting Statement 2020 30day doc.docx Supporting Statement A	2020-07-31

IC Document Collections

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

ICR Details

OMB Control No: 1405-0150	ICR Reference No: 202007-1405-004
Status: Received in OIRA	Previous ICR Reference No: 201906-1405-002
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Repatriation/Emergency Medical and Dietary Assistance Loan Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/31/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	1,459	1,459
Time Burden (Hours)	486	486
Cost Burden (Dollars)	39,861	38,830

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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 2671 Name of Law: Emergency expenditures
   US Code: 22 USC 2670 Name of Law: Responsibility of Secretary of State
  

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:
	85 FR 28691	05/13/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 46207	07/31/2020
Did the Agency receive public comments on this ICR? Yes

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

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

	Total Request	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	1,459	0	0	0	0
Annual Time Burden (Hours)	486	486	0	0	0	0
Annual Cost Burden (Dollars)	39,861	38,830	0	1,031	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $28,888

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 07/31/2020

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