Information Collection

Evacuee Manifest and Promissory Note

IC 277600 under ICR 202509-1405-003 · OMB 1405-0211.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DS-5528 Evacuee Manifest and Promissory Note	Form and Instruction
Form DS-5528 Evacuee Manifest and Promissory Note Evacuee Manifest and Promissory Note	Form and Instruction
Form Old DS-5528 Evacuee Manifest and Promissory Note Evacuee Manifest and Promissory Note	Form and Instruction
DS-5528 Evacuee Manifest and Promissory Note ds5528 - DRAFT - 09-12-2025.pdf	Form and Instruction
DS-5528 Evacuee Manifest and Promissory Note ds5528 - DRAFT - 09-12-2025.pdf	Form and Instruction
Old DS-5528 Evacuee Manifest and Promissory Note ds5528 Old Version.pdf	Form and Instruction
Old DS-5528 Evacuee Manifest and Promissory Note ds5528 Old Version.pdf	Form and Instruction

IC Title:

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 Part 71 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	DS-5528				Yes	No	Fillable Printable
Form and Instruction	Old DS-5528				Yes	No	Fillable Printable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records

Title: Overseas Citizens Services Records - State 05

FR Citation: 73 FR 24342

Number of Respondents: 525

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	525	525
Annual IC Time Burden (Hours)	175	175
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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