Information Collection

Repatriation Repayment and Privacy Agreement

IC 218657 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⚠️ Notice: This information collection may be referencing outdated material.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-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:

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-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: OHSEPR Repatriation and Disaster Human Services Case Management Records 09â80â0389

FR Citation: 88 FR 63109

Number of Respondents: 800

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	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

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.