U.S. Repatriation Program Forms

ICR 201903-0970-002

OMB: 0970-0474

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Supporting Statement A
2019-03-18
ICR Details
0970-0474 201903-0970-002
Active 201510-0970-006
HHS/ACF OHSEPR
U.S. Repatriation Program Forms
Extension without change of a currently approved collection   No
Regular
Approved without change 04/29/2019
Retrieve Notice of Action (NOA) 03/29/2019
  Inventory as of this Action Requested Previously Approved
04/30/2022 36 Months From Approved 04/30/2019
51,524 0 51,524
9,204 0 9,204
0 0 0

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.

US Code: 42 USC 1313 Name of Law: Social Security Act
   US Code: 24 USC 321-329 Name of Law: Hospitals and Asylums
   EO: EO 12656 Name/Subject of EO: Assignment of Emergency Preparedness Responsibilities
  
None

Not associated with rulemaking

  84 FR 739 01/31/2019
84 FR 11982 03/29/2019
No

  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 51,524 51,524 0 0 0 0
Annual Time Burden (Hours) 9,204 9,204 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$40,708
No
    Yes
    No
No
No
No
Uncollected
Molly Buck 202 205-4724 mary.buck@acf.hhs.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/29/2019


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