SUPPORTING STATEMENT FOR
PAPERWORK REDUCTION ACT
SUBMISSION
Crisis
Assistance Request Form - Ukraine (Dept. of State)
OMB
Number 1405-XXXX
Why is this collection necessary and what are the legal statutes that allow this?
The information on this form is requested pursuant to Executive Order 12656 (Assignment of emergency preparedness responsibilities), the Vienna Convention on Consular Relations, 8 U.S.C. § 1101 et seq. (Immigration and Nationality Act), and U.S. Department of State authorities providing for consular and emergency assistance and visa functions, including 22 U.S.C. § 4802(b) (Overseas evacuations), 22 U.S.C. § 3904 (Functions of Service), 22 U.S.C. § 2671 (Emergency Expenditures), and 22 U.S.C. § 2656 (Management of Foreign Affairs).
What business purpose is the information gathered going to be used for?
The purpose of the collection is to enable the Department of State to better communicate with U.S. citizens and lawful permanent residents (LPRs) who may be in need of assistance in departing Ukraine, amid continued Russian efforts to destabilize the country and undermine the security of Ukrainian citizens and others visiting or residing in Ukraine.
The form asks U.S. citizens and lawful permanent residents (LPRs) currently in Ukraine to share information with us about their current plans, the number of people in their group, and their exact location. It also asks for their latest contact information, and also contact information for an emergency contact not currently in Ukraine.
The Department is utilizing this form to acquire the most current and accurate data possible to inform our consular assistance efforts. It will allow us to build a more current picture of how many U.S. citizens plan to remain in Ukraine and any who may need reimbursable loan assistance to depart.
Is this collection able to be completed electronically (e.g. through a website or application)?
The collection will be completed 100% electronically. The respondent accesses the form at the following link: https://cacms.state.gov/s/crisis-intake. The link is accessible from the Ukraine country information page on www.travel.state.gov and from the U.S. Embassy Kiev web site, and other Department of State communications. The Department may also choose as appropriate to distribute the form’s URL through emails from @state.gov email addresses, or in messaging sent as consular information products (such as MASCOT messages).
Does this collection duplicate any other collection of information?
This collection will not duplicate any other collection of information. The form complements the existing Smart Traveler Enrollment Program (STEP) as a situation-specific tool that helps us to gather current information to best serve U.S. citizens and LPRs currently in Ukraine.
Describe any impacts on small business.
There is no impact on small business.
What are consequences if this collection is not done?
The Department would be hindered in its contingency planning and in potential operational efforts to assist U.S. citizens and LPRs in departing Ukraine if this collection is not done. The Department requires an online collection tool that can be readily used by individuals in need specifically in the crisis region – and those in the United States or elsewhere who may be acting on their behalf – to submit requests for consular assistance.
The online form helps avoid unstructured requests for assistance, such as those that arrive via e-mail messages, which may not include necessary individual information and which often require entry into other systems in order to facilitate responses. This form is integrated with other elements of the Department’s evolving information technology platform used in crisis-management situations, making it an important tool in the efficient handling of individual cases.
Are there any special collection circumstances?
No, other than the ongoing Russian efforts to destabilize Ukraine, which could intensify at any time.
Document publication (or intent to publish) a request for public comments in the Federal Register
The Department is requesting emergency approval of this collection. Subsequent to such approval, and subject to potentially providing additional supporting information regarding how the form might be adapted to and used in other crisis situations worldwide, the Department intends to publish a Federal Register Notice and seek public comment on the collection, including to inform future enhancements or modifications to the collection.
Are payments or gifts given to the respondents?
No.
Describe assurances of privacy/confidentiality
All information will be handled in accordance with the Privacy Act (5 U.S.C. § 552a) and other applicable rules for safeguarding personally identifiable information. The form includes a Privacy Act Statement & Consent to Sharing notice that informs respondents of the purpose for the collection; relevant statutory authorities; that completion is voluntary but that the United States government will be constrained in efforts to provide appropriate assistance; and that information may be shared with other U.S. and foreign governmental authorities, with transportation carriers, with relevant family members and others, if they are in a position to assist in connection with the consular functions requested. Respondents are informed that submission of their request indicates their consent to the Department sharing information for such purposes.
Are any questions of a sensitive nature asked?
No questions of a sensitive nature are asked.
Describe the hour time burden and the hour cost burden on the respondent needed to complete this collection
The Department anticipates that as many as 7,000 U.S. citizens and LPRs currently in Ukraine, and/or their U.S.-based family members, may complete this form. That estimate is based on the number of U.S. citizens who have previously provided information in STEP. U.S. citizens are not required to complete this form, however, nor otherwise to register their travel to a foreign country with us, so while our estimates are based on the best currently available specific information, estimates cannot be considered authoritative. The total number of submissions is also heavily dependent on actual developments in Ukraine.
The form takes approximately 5 minutes to
complete, resulting in an estimated time burden of 583.3 hours (7,000
x 5 minutes) and an estimated annual cost burden of $14,210. The
estimated cost to respondents is based on the civilian hourly wage
from the Bureau of Labor Statistics website multiplied by the annual
time burden. The wage rate is estimated to be $24.36. The
Department used the Employer Costs for Employee Compensation released
by the Bureau of Labor Statistics in 2020.1
Describe the monetary burden to respondents (out of pocket costs) needed to complete this collection.
There are no out-of-pocket costs to the respondents.
Describe the cost incurred by the Federal Government to complete this collection.
There will be no new cost to the federal government to set up this collection. The collection instrument is made available through an existing Department platform. The responses will be reviewed by Department employees in the normal course of their duties, including on dedicated task forces pertaining to the situation in Ukraine.
Explain any changes/adjustments to this collection since the previous submission
This is a new information collection.
Specify if the data gathered by this collection will be published.
The information collected pursuant to this collection will not be published.
If applicable, explain the reason(s) for seeking approval to not display the OMB expiration date. Otherwise, write “The Department will display the OMB expiration date.”
The Department will display the OMB expiration date.
Explain any exceptions to the OMB certification statement below. If there are no exceptions, write “The Department is not seeking exceptions to the certification statement”.
The Department is not seeking exceptions to the certification statement.
This collection does not employ statistical methods.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Canfield, Danielle P |
| File Modified | 0000-00-00 |
| File Created | 2022-03-01 |