Emergency Loan Application and Evacuation Documentation

Forms and Documents

Document Name	Status
Form DS-3072 Emergency Loan Application and Evacuation Documentation Form and Instruction	Modified
Legal Authorities ds 3072 (2007-1-17).doc Supplementary Document	2007-02-12
Supporting Statement DS 3072 (2007-1-17).doc Supporting Statement A	0000-00-00

IC Document Collections

IC ID	Document Title	Status
15037	Emergency Loan Application and Evacuation Documentation Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0150	ICR Reference No: 200702-1405-001
Status: Historical Active	Previous ICR Reference No: 200309-1405-007
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Emergency Loan Application and Evacuation Documentation
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/13/2007
	Date Received in OIRA: 02/12/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	36 Months From Approved	03/31/2007
Responses	1,000	0	500
Time Burden (Hours)	166	0	83
Cost Burden (Dollars)	0	0	0

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Abstract: The DS 3072 is an application for an emergency loan for a destitute U.S. citizen and/or dependent to return to the United States, an application for a destitute U.S. citizen abroad to receive emergency medical and dietary assistance and an application for a U.S. citizen and/or dependent and a third country or host country national to receive a loan to assist in his or her evacuation from a foreign country during a time of crisis or unrest. The DS 3072 also serves as an evacuation documentation to facilitate processing of evacuees by consular officers and state, federal and local government officials receiving evacuees.

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Authorizing Statute(s): US Code: 22 USC 4802 (b) Name of Law: Responsibility of Secretary of State
   US Code: 22 USC 2671 Name of Law: Emergency expenditures
   US Code: 22 USC 2715 Name of Law: Procedures regarding major disasters and incidents abroad affecting United States citizens
   US Code: 42 USC 1313 Name of Law: THE PUBLIC HEALTH AND WELFARE
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 216	11/08/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 27	02/02/2007
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Emergency Loan Application and Evacuation Documentation	DS-3072	Emergency Loan Application and Evacuation Documentation

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,000	500	0	0	500	0
Annual Time Burden (Hours)	166	83	0	0	83	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden increase is due to Agency estimates based on increased number of applicants.

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Annual Cost to Federal Government: $669,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/12/2007

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