Information Collection

Crisis Assistance Request Form - (Dept. of State)

IC 261711 under ICR 202506-1405-002 · OMB 1405-0259.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1405-0259 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Crisis Assistance Request Form Crisis Assistance Request Form - (Dept. of State)	Form and Instruction
0259 Instrument.docx mytravel.state.gov/s/crisis-intake	Other-Requested change
Crisis Assistance Request Form CACMS Public Pages Screenshot 1-27-2-23.docx	Form and Instruction

IC Title:

Crisis Assistance Request Form - (Dept. of State)

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

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	NA				Yes	Yes	Fillable Fileable
Other-Requested change				https://mytravel.state.gov/s/crisis-intake	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	120,000	120,000
Annual IC Time Burden (Hours)	10,000	10,000
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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