Information Collection

Repatriation Repayment and Privacy Agreement

IC 218657 under ICR 202502-0970-024 · OMB 0970-0474.

⚠️ Notice: This information collection may be referencing outdated material.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

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
Form RR-05 Repatriation Repayment and Privacy Agreement Repatriation Repayment and Privacy Agreement	Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement RR-05 Repatriation Repayment and Privacy Agreement - Jan2025Update - CLEAN.docx	Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement RR-05 Repatriation Repayment and Privacy Agreement - Jan2025Update - CLEAN.docx	Form and Instruction

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RR-05				Yes	Yes	Fillable Printable

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.

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