Repatriation Repayment and Privacy Agreement

U.S. Repatriation Program Forms

OMB: 0970-0474

IC ID: 218657

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0474 can be found here:

2023-11-27 - Revision of a currently approved collection

Documents and Forms

Document Name Document Type
Form RR-05 Repatriation Repayment and Privacy Agreement Form and Instruction
Form RR-05 Repatriation Repayment and Privacy Agreement Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement RR-05 Repatriation Repayment and Privacy Agreement (2).docx Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement RR-05 Repatriation Repayment and Privacy Agreement (2).docx Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Arabic RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_ar 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Arabic RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_ar 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - French RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_fr 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - French RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_fr 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Russian RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_ru 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Russian RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_ru 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Simplifie RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_zh_cn 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Simplifie RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_zh_cn 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Spanish RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_es_508pdf.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Spanish RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_es_508pdf.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Tradition RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_zh_TW 508.pdf Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement - Tradition RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_zh_TW 508.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Repatriation Repayment and Privacy Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement	RR-05 Repatriation Repayment and Privacy Agreement (2).docx	Yes	Yes	Fillable Printable
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement - Arabic	RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_ar 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement - French	RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_fr 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement - Russian	RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_ru 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement - Simplified Chinese	RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_zh_cn 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement - Spanish	RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_es_508pdf.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement - Traditional Chinese	RR-05 Repatriation Repayment and Privacy Agreement - STANDARD_zh_TW 508.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	136	136
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.