U.S. Repatriation Program Forms

OMB 0970-0474

OMB 0970-0474

This information is being requested in order to carry out the functions of the U.S. Repatriation Program. This program is authorized by Section 1113 of the Social Security Act (42 U.S.C. § 1313) and the assistance provided to mentally ill repatriates found under 24 U.S.C. §§ 321 - 329. This program also provides services under emergency and group repatriations which are authorized under Section 1113 and by the extension of the Executive Order (E.O.) precedent, E.O. 12656 (53 CFR 47491). General program regulations are found under 45 CFR 211 & 212. These laws and regulations require HHS to obtain specific information to determine eligibility for HHS repatriation, to provide services to eligible repatriates, to reimburse states for services provided and to collect repatriation loans from repatriates. This collection of information was originally approved on March 4, 2016. This current request is for an extension with no changes to the data collection elements. Forms were updated to make minor grammatical edits and to update phone numbers and addresses to be current.

The latest form for U.S. Repatriation Program Forms expires 2022-04-30 and can be found here.

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Emergency and Group Processing

Federal Enterprise Architecture: Community and Social Services - Social Services

Form 1Emergency and Group Processing FormFillable PrintableForm and instruction

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