OMB control number
Crisis Assistance Request Form - (Dept. of State)
OMB 1405-0259 ยท STATE/AFA.
OMB 1405-0259
The purpose of the collection is to enable the Department of State to better identify and communicate with U.S. citizens and Lawful Permanent Residents (LPRs) who may need consular assistance during a crisis overseas.
The latest form for Crisis Assistance Request Form - (Dept. of State) expires 2026-09-30 and is listed under ICR 202506-1405-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Crisis Assistance Request Form | Form and Instruction |
| CACSM Crisis Form - Legal Authorities.docx | Supplementary Document |
| Change Required 1405-0259.docx | Justification for No Material/Nonsubstantive Change |
| CACMS Privacy Act Statement (002).docx | Supplementary Document |
 30 Day FRN.pdf | Supplementary Document |
| 2022-22211.pdf | Supplementary Document |
| Crisis Form - Legal Authorities (2-28-22) - Copy.docx | Supplementary Document |
| Supporting Statement - Generic Online form 30 Day Notice.docx | Supporting Statement A |
 Crisis Assistance Request Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202607-1405-004 | Revision of a currently approved collection | 2026-07-20 | ||
| 202506-1405-002 | No material or nonsubstantive change to a currently approved collection | 2025-06-24 | Approved without change | |
| 202306-1405-004 | New collection (Request for a new OMB Control Number) | 2023-06-28 | Approved with change |