OPRE OMB Clearance Manual

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Potential Support Interest Form | U.S. Repatriation Program Services for U.S. Citizens Returning Home from the Middle East

Formative Data Collections for Program Support

0970 – 0531


Supporting Statement
Part A - Justification
MARCH 2026

Submitted By:
Office of Human Services Emergency Preparedness and Response
Administration for Children and Families 
U.S. Department of Health and Human Services

4th Floor, Mary E. Switzer Building
330 C Street, SW
Washington, D.C. 20201






A1. Necessity for the Data Collection
The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval of a brief interest form for U.S. citizens to identify interest in potential support through the U.S. Repatriation Program, following the U.S. Department of State’s (DOS) ordered departure from fourteen countries across the Middle East. Socialization of this form would reduce burden on incoming U.S. citizens seeking support as they return home and set them on a path towards self-sufficiency in the United States. 

Background 
The Office of Human Services Emergency Preparedness and Response (OHSEPR) is seeking to circulate a brief interest form to quickly capture potential repatriates’ eligibility, circumstances, and needs in Program services. With an anticipated influx of potential repatriates following the DOS ordered departure from the Middle East, the form will enable Program personnel to prioritize outreach and connect individuals to appropriate services promptly upon arrival in the United States. This is not intended to be an enrollment for services; data collection for enrollment in services is approved under OMB #0970-0474.

Legal or Administrative Requirements that Necessitate the Collection 
Section 42 U.S.C. § 1313 (c) of the United States Code (USC) designates the U.S. Repatriation Program the authority to authorize, reimburse and utilize facilities of public or private agencies and organizations “to provide temporary assistance to citizens of the United States and to dependents of citizens of the United States, if they (A) are identified by the Department of State as having returned, or been brought, from a foreign country to the United States because of the destitution of the citizen of the United States or the illness of such citizen or any of his dependents or because of war, threat of war, invasion, or similar crisis, and (B) are without available resources.” Section 801 of Executive Order 12656 (53 CFR 47491) as amended, designated HHS as the lead federal agency (LFA) responsible to “develop plans and procedures, in coordination with the heads of federal departments and agencies, for assistance to United States citizens or others evacuated from overseas areas.” As federal lead for the U.S. Repatriation Program, OHSEPR has the responsibility to develop, implement, and validate plans and procedures related to ensuring the safe and efficient provision of Program services to eligible U.S. citizens. An effective and coordinated response requires that all partners have a clear, tested understanding of their roles and responsibilities before, during, and after an incident involving the repatriation of U.S. citizens.

A2. Purpose of Interest Form and Data Collection Procedures
Overview of Purpose and Use
To reduce the burden on incoming U.S. citizens seeking repatriation support, OHSEPR intends to link a quick, two-minute repatriation support interest form on their website. This form is purely intended to gather contact information from interested individuals so case managers may reach out and determine their eligibility. This form is not an eligibility determination nor enrollment of services, which is clearly stated on the survey landing page. If individuals are interested in the enrollment of services, the forms for that process are approved under OMB #0970-0474.

This initiative reflects the growing need to improve the efficiency of the program’s intake method, as potentially eligible repatriates are returning from multiple U.S. DOS-identified ordered departure locations to ports of entry (POEs) around the country without a consistent method to contact the Program or be identified by Program partners. Collecting targeted information will improve program processes as the information from the interest form will help Program case managers connect with potential repatriates more efficiently, allowing the program to improve support services. 

Information collected from this interest form will be used to identify U.S. citizens who may be eligible for the Program and are interested in temporary assistance. Program case managers use the information; supporting timely connections to appropriate services and improving overall Program outreach. 

This proposed information collection meets the following goals of ACF’s generic clearance for formative data collections for program support (0970-0531): 
    • Planning for provision of programmatic or evaluation-related T/TA.
    • Development or refinement of program processes. 

Processes for Information Collection 
To ensure that this activity addresses the unique aspects of emergency and routine operations, OHSEPR representatives will disseminate the interest form as a Microsoft Forms outreach via the OHSEPR U.S. Repatriation website. Responses will be used by case managers to better identify potential repatriates and determine eligibility and next steps as potential repatriates arrive to various POEs.  

A3. Improved Information Technology to Reduce Burden
Respondents will have access to the interest form via the OHSEPR U.S. Repatriation Program website and complete the interest form electronically utilizing Microsoft Forms.

A4. Efforts to Identify Duplication
Insights collected from this interest form have not been documented elsewhere. 

A5. Involvement of Small Organizations
No small businesses will be involved with this information collection.

A6. Consequences of Less Frequent Data Collection
This is a one-time data collection.

A7. Special Circumstances
There are no special circumstances for the proposed data collection efforts.

A8. Federal Register Notice and Consultation
Federal Register Notice and Comments
In accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13) and Office of Management and Budget (OMB) regulations at 5 CFR Part 1320 (60 FR 44978, August 29, 1995), ACF published a notice in the Federal Register announcing the agency’s intention to request an OMB review of this information collection request to extend approval of the umbrella generic with minor changes. The notice was published on April 28, 2025, (90 FR 17603), and provided a sixty-day period for public comment. ACF did not receive any comments on the first notice. A second notice was published, allowing a thirty-day period for public comment (90 FR 42248, in conjunction with submission of the request to OMB. ACF did not receive any comments on the second notice.  

Consultation with Outside Experts
No consultations have taken place with experts outside of the project team.

A9. Tokens of Appreciation for Respondents
No tokens of appreciation for respondents are proposed for this information collection.

A10. Privacy of Respondents
Information collected will be kept private to the extent permitted by law. Respondents will be informed of all planned uses of data, that their participation is voluntary, and that their information will be kept private to the extent permitted by law. 

This interest form aims to collect information about U.S. citizens returning to the United States from a DOS-identified ordered departure country, including name, contact information, country of origin, and potential Program service needs. The information will be used to help determine potential eligibility and, for those potentially eligible, connect them with OHSEPR case managers who are able to process the next steps for Program enrollment should respondents provide their contact information. OHSEPR will keep all response information internal, and will not share any responder data.  

A11. Sensitive Questions
There are no sensitive questions in this data collection.




A12. Estimation of Information Collection Burden
Burden Estimates
The number of respondents depends and varies on the number of U.S. citizens departing from a DOS-identified departure country who are seeking assistance upon their return. The estimated number of respondents is currently based on the number of enrolled repatriates in the Afghanistan evacuation in Operation Allies Welcome. The interest form will take about 2 minutes to complete, based on number of and simplicity of questions. This time is an average estimated time to complete, with the assumption that not all respondents will complete all questions.   

Cost Estimates
Some repatriates are employed and many are unemployed.  Therefore, their wage is calculated as the average minimum wage among the states in 2024 ($13.23).  The total annual cost for repatriates to complete the form is $13.23 times 20 or $264.60.

Instrument
Total Number of Respondents
Total Number of Responses Per Respondent
Average Burden Hours Per Response
Total
Burden Hours
Average Hourly Wage
Total Annual Cost
Potential Support Interest Form | U.S. Repatriation Program Services for U.S. Citizens Returning Home from the Middle East
600
1
.034
20
$13.23
$264.60

A13. Cost Burden to Respondents or Record Keepers
There are no additional costs to respondents.

A14. Estimate of Cost to the Federal Government
The total cost for the data collection activities under this current request will be $9,682.70. 

This estimate is developed based on a $60/hourly rate for 3 contractors for 50 hours of work each ($9,000), in addition to one federal employee, estimated at GS-14, Step 1 ($68.27/hour), for 10 hours of work ($682.70).

A15. Change in Burden
This is for an individual information collection under the umbrella formative generic clearance for program support (0970-0531). 




A16. Plan and Time Schedule for Information Collection, Tabulation and Publication
The information collection will occur following OMB approval over about six weeks. The information will be compiled and shared with OHSEPR Program support and case managers. The results and data collected from this interest form will not be published.

A17. Reasons Not to Display OMB Expiration Date
All instruments will display the expiration date for OMB approval.

A18. Exceptions to Certification for Paperwork Reduction Act Submissions
No exceptions are necessary for this information collection.