Information Collection

Routine Repatriation Reimbursement Request

IC 218656 under ICR 202311-0970-008 · OMB 0970-0474.

⚠️ Notice: This information collection may be referencing outdated material.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

2026-02-17 - No material or nonsubstantive change to a currently approved collection
2025-02-13 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form RR-04 Routine Repatriation Reimbursement Request	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request RR-04 Routine Repatriation Reimbursement Request (1).docx	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request RR-04 Routine Repatriation Reimbursement Request (1).docx	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Arabic RR-04 Routine Repatriation Reimbursement Request - STANDARD_ar 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Arabic RR-04 Routine Repatriation Reimbursement Request - STANDARD_ar 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - French RR-04 Routine Repatriation Reimbursement Request - STANDARD_fr 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - French RR-04 Routine Repatriation Reimbursement Request - STANDARD_fr 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Russian RR-04 Routine Repatriation Reimbursement Request - STANDARD_ru 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Russian RR-04 Routine Repatriation Reimbursement Request - STANDARD_ru 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Simplified RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_cn 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Simplified RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_cn 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Spanish RR-04 Routine Repatriation Reimbursement Request - STANDARD_es_508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Spanish RR-04 Routine Repatriation Reimbursement Request - STANDARD_es_508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Traditional RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_TW 508.pdf	Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Traditional RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_TW 508.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Routine Repatriation Reimbursement Request

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:

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	RR-04	Routine Repatriation Reimbursement Request	RR-04 Routine Repatriation Reimbursement Request (1).docx	Yes	Yes	Fillable Printable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Arabic	RR-04 Routine Repatriation Reimbursement Request - STANDARD_ar 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - French	RR-04 Routine Repatriation Reimbursement Request - STANDARD_fr 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Russian	RR-04 Routine Repatriation Reimbursement Request - STANDARD_ru 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Simplified Chinese	RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_cn 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Spanish	RR-04 Routine Repatriation Reimbursement Request - STANDARD_es_508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Traditional Chinese	RR-04 Routine Repatriation Reimbursement Request - 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: OHSEPR Repatriation and Disaster Human Services Case Management Records 09â80â0389

FR Citation: 88 FR 63109

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	75	75
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.