Form DS-7675 FOREIGN MISSION EMERGENCY AFTER-HOURS CONTACT

U.S. Department of State

FOREIGN MISSION EMERGENCY AFTER-HOURS CONTACT

OMB APPROVAL NO. 1405-0105
EXPIRES: xx-xx-xxxx
ESTIMATED BURDEN: 15 Minutes*

Emergency management is a discipline that involves preparing for a disaster before it occurs, responding to it (i.e., emergency evacuation), and
assisting after the disaster has occurred. For prompt contact with embassies and consulates to ensure the Department of State can deliver information
and guidance in the event of an emergency, the Office of Foreign Missions is requesting after-hours emergency contact information of the senior
officials for all diplomatic and consular missions in the United States. All information is treated as sensitive and will be shared only with agencies
assigned to assist during a crisis situation. To that end, the Department would appreciate the following information:

GENERAL INFORMATION (Please type or print the information requested in the spaces below)
1. From (Name of Country/Organization)

2. Mission Physical Address

Mission Function

City

State

ZIP Code

(Click)
3. Mission Working Hours

4. Mission Phone Number

5. Mission Fax Number

CONTACT INFORMATION
Provide the names, titles, after-hours phone numbers (including area codes), and e-mails of at least two Senior Officials (e.g., Ambassador, Consul
General, etc.) who can be reached in the event of an emergency.
6. First Contact
Name

Title

Phone Number 1 (Specify Cell or Home)
Cell

Home E-mail

Phone Number 2 (Specify Cell or Home)
Home

Cell

Home Fax Number
Home

7. Second Contact
Name

Title

Phone Number 1 (Specify Cell or Home)
Cell

Home E-mail

Phone Number (Specify Cell or Home)
Home

Cell

Home Fax Number
Home

8. Third Contact (Optional)
Name

Title

Home E-mail

Home Phone Number

Cell Phone Number

Home Fax Number

Duty Officer Title

Duty Officer Phone Number

9. 24-Hour Duty Office
Duty Officer Name

Comments (If this is a rotational responsibility, please note and provide details.)

DS-7675
xx-xxxx

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PRIVACY ACT STATEMENT
AUTHORITIES: The information is sought pursuant to Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular Relations
of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e (a)); Foreign Missions Act of 1982
(22 U.S.C. 4301-4316) as amended.
PURPOSE: The information solicited on this form will be used to contact embassies and consulates and to ensure the U.S. Department of State can
deliver information and guidance in the event of an after-hours emergency/disaster.
ROUTINE USES: The information provided on this form may be provided to other federal agencies for law enforcement, administrative or other
statutorily authorized purposes as covered under STATE 36, Security Records. This information also may be provided to the employing foreign
government or international organization.
DISCLOSURE: Providing this information is voluntary; Failure to provide the information requested on this form may result in the Office of Foreign
Missions inability to assist after an emergency/disaster.
PAPERWORK REDUCTION ACT STATEMENT
*Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection.
You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the
accuracy of this burden estimate and/or recommendations for reducing it, please send them to: M/OFM, 3507 International Place NW, Washington,
DC 20008.

DS-7675

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