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Federal forms, ICRs, and supporting documents

OMB control number

Evacuee Manifest and Promissory Note

OMB 1405-0211 ยท STATE/AFA.

OMB 1405-0211

The DS 5528, Evacuee Manifest and Promissory Note, is used to document the evacuation of persons from abroad when their lives are endangered by war, civil unrest, or natural disaster; document issuance of a crisis evacuation loan; to obtain a Privacy Act waiver to share information about the welfare of a citizen or lawful permanent resident with designated persons; and to facilitate debt collection.

The latest form for Evacuee Manifest and Promissory Note expires 2027-06-30 and is listed under ICR 202509-1405-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form Old DS-5528 Evacuee Manifest and Promissory NoteForm and Instruction
Form DS-5528 Evacuee Manifest and Promissory NoteForm and Instruction
Form DS-5528 Evacuee Manifest and Promissory NoteForm and Instruction
Form DS-5528 EVACUEE MANIFEST AND PROMISSORY NOTEForm and Instruction
Form DS-5528 Evacuee Manifest and Promissory NoteForm and Instruction
Form DS-5528 Evacuee Manifest and Promissory NoteForm
Form DS-5528 Evacuee Manifest and Promissory NoteForm and Instruction
Form DS-5528 Evacuee Manifest and Promissory NoteForm and Instruction
Justification for Change to DS- 5528 - 1405-0211.docxJustification for No Material/Nonsubstantive Change
Justification for Change to DS- 5528 - 1405-0211.docx Justification for No Material/Nonsubstantive Change
ds5528 - DRAFT - 06-06-2024.pdfJustification for No Material/Nonsubstantive Change
ds5528 - DRAFT - 06-06-2024.pdf Justification for No Material/Nonsubstantive Change
Justification for Non-substantive change.docxJustification for No Material/Nonsubstantive Change
Justification for Non-substantive change.docx Justification for No Material/Nonsubstantive Change
5528 langauge.docxSupplementary Document
5528 langauge.docx Supplementary Document
2024 04 04 Answers to OIRA 2020 Questions DS 5528 Supporting Statement.docxSupplementary Document
2024 04 04 Supporting Statement Updated.docxSupporting Statement A
2024 04 04 Supporting Statement Updated.docxSupporting Statement A
Final Legal Authorities DS-5528.docxSupplementary Document
Final Legal Authorities DS-5528.docx Supplementary Document
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202509-1405-003 No material or nonsubstantive change to a currently approved collection 2025-09-18
202406-1405-005 No material or nonsubstantive change to a currently approved collection 2024-06-13 Approved without change
202404-1405-001 Reinstatement without change of a previously approved collection 2024-04-15 Approved without change
202007-1405-003 Revision of a currently approved collection 2020-07-31
201906-1405-003 No material or nonsubstantive change to a currently approved collection 2019-06-26 Approved without change
201807-1405-003 No material or nonsubstantive change to a currently approved collection 2018-07-11 Approved without change
201705-1405-003 Extension without change of a currently approved collection 2017-05-12 Approved without change
201602-1405-007 No material or nonsubstantive change to a currently approved collection 2016-02-12 Approved with change
201601-1405-005 No material or nonsubstantive change to a currently approved collection 2016-01-29 Improperly submitted and continue
201601-1405-004 Revision of a currently approved collection 2016-01-28 Improperly submitted and continue
201504-1405-001 Extension without change of a currently approved collection 2015-04-14 Approved with change
201305-1405-002 New collection (Request for a new OMB Control Number) 2013-05-14 Approved with change

OMB Details

Evacuee Manifest and Promissory Note

Federal Enterprise Architecture: Disaster Management - Emergency Response

Information collection instruments
FormNameElectronic accessType
Form DS-5528Evacuee Manifest and Promissory NoteFillable PrintableForm and instruction
Form DS-5528Evacuee Manifest and Promissory NotePaper OnlyForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.