Information Collection

Crisis Assistance Request Form - Ukraine

IC 251891 under ICR 202202-1405-009 · OMB 1405-0248.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Crisis Assistance Request Form - Ukraine	Form and Instruction
Ukraine Crisis Intake Form Ukraine Crisis Intake Form (screenshot).docx cacms.state.gov/s/crisis-intake	Form and Instruction
Ukraine Crisis Intake Form Ukraine Crisis Intake Form (screenshot).docx cacms.state.gov/s/crisis-intake	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.13

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Ukraine Crisis Intake Form	Ukraine Crisis Intake Form (screenshot).docx	https://cacms.state.gov/s/crisis-intake	Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Border and Transportation Security

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,000	7,000
Annual IC Time Burden (Hours)	583	583
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.