Repatriation/Emergency Medical and Dietary Assistance Loan Application

Documents and Forms

Document Name Document Type
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction
DS-3072 Repatriation/Emergency Medical and Dietary Assistance Lo MS Forms DS-3072 Screenshots.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Repatriation/Emergency Medical and Dietary Assistance Loan Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 22 CFR 71

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DS-3072	Repatriation/Emergency Medical and Dietary Assistance Loan Application MS Form	MS Forms DS-3072 Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: Foreign Affairs

Privacy Act System of Records
Title: REPATRIATION/EMERGENCY MEDICAL AND DIETARY ASSISTANCE LOAN APPLICATION	FR Citation: 85 FR 46207

Number of Respondents: 1,459	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,459	1,459
Annual IC Time Burden (Hours)	486	486
Annual IC Cost Burden (Dollars)	38,830	38,830

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.