U.S. Repatriation Program Forms

ICR 202311-0970-008

OMB: 0970-0474

Federal Form Document

ICR Details
0970-0474 202311-0970-008
Received in OIRA 202304-0970-011
HHS/ACF OHSEPR
U.S. Repatriation Program Forms
Revision of a currently approved collection   No
Regular 11/27/2023
  Requested Previously Approved
36 Months From Approved 06/30/2025
5,140 2,535
1,470 802
0 0

The U.S. Repatriation Program (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 for emergency repatriations which are authorized under Section 1113 and by the extension of the Executive Order (E.O.) precedent, E.O. 12656 (53 CFR 47491). Program regulations are in 45 CFR 211 & 212. The current collection includes eight forms with translations in six languages. The information collected through these forms allows the Office of Human Services Emergency Preparedness and Response (OHSEPR) to fulfill its statutory responsibilities to provide temporary assistance to repatriates. The Program also provides training and technical assistance to states and territories for routine and emergency repatriation. Additionally, OHSEPR provides funding to states for emergency repatriation planning, training, and exercises. OHSEPR is proposing six new forms to support these activities.

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

Not associated with rulemaking

  88 FR 15728 03/14/2023
88 FR 81087 11/21/2023
No

14
IC Title Form No. Form Name
Emergency Repatriation Eligibility Application RR-01, RR-01 , RR-01, RR-01, RR-01, RR-01, RR-01 Emergency Repatriation Eligibility Application ,   Emergency Repatriation Eligibility Application - Arabic ,   Emergency Repatriation Eligibility Application - French ,   Emergency Repatriation Eligibility Application - Russian ,   Emergency Repatriation Eligibility Application - Simplified Chinese ,   Emergency Repatriation Eligibility Application - Spanish ,   Emergency Repatriation Eligibility Application - Traditional Chinese
Emergency Repatriation Reimbursement Request RR-02, RR-02, RR-02, RR-02, RR-02, RR-02, RR-02 Emergency Repatriation Reimbursement Request ,   Emergency Repatriation Reimbursement Request - Arabic ,   Emergency Repatriation Reimbursement Request - French ,   Emergency Repatriation Reimbursement Request - Russian ,   Emergency Repatriation Reimbursement Request - Simplified Chinese ,   Emergency Repatriation Reimbursement Request - Spanish ,   Emergency Repatriation Reimbursement Request - Traditional Chinese
Emergency Repatriation Request for Cost Approval and Federal Support RR-08, RR-08, RR-08, RR-08, RR-08, RR-08, RR-08 Emergency Repatriation Request for Cost Approval and Federal Support ,   Emergency Repatriation Request for Cost Approval and Federal Support - Arabic ,   Emergency Repatriation Request for Cost Approval and Federal Support - French ,   Emergency Repatriation Request for Cost Approval and Federal Support - Russian ,   Emergency Repatriation Request for Cost Approval and Federal Support - Simplified Chinese ,   Emergency Repatriation Request for Cost Approval and Federal Support - Spanish ,   Emergency Repatriation Request for Cost Approval and Federal Support - Traditional Chinese
Loan Waiver and Deferral Application RR-03, RR-03, RR-03, RR-03, RR-03, RR-03, RR-03 Loan Waiver and Deferral Application ,   Loan Waiver and Deferral Application - Arabic ,   Loan Waiver and Deferral Application - French ,   Loan Waiver and Deferral Application - Russian ,   Loan Waiver and Deferral Application - Simplified Chinese ,   Loan Waiver and Deferral Application - Spanish ,   Loan Waiver and Deferral Application - Traditional Chinese
Planning, Training, and Exercise – Annual Workplan
Planning, Training, and Exercise – Budget and Budget Narrative
Planning, Training, and Exercise – Project Narrative
Refusal of Temporary Assistance RR-06, RR-06, RR-06, RR-06, RR-06, RR-06, RR-06 Refusal of Temporary Assistance ,   Refusal of Temporary Assistance - Arabic ,   Refusal of Temporary Assistance - French ,   Refusal of Temporary Assistance - Russian ,   Refusal of Temporary Assistance - Simplified Chinese ,   Refusal of Temporary Assistance - Spanish ,   Refusal of Temporary Assistance - Traditional Chinese
Repatriation Post-Training Survey
Repatriation Repayment and Privacy Agreement RR-05, RR-05, RR-05, RR-05, RR-05, RR-05, RR-05 Repatriation Repayment and Privacy Agreement ,   Repatriation Repayment and Privacy Agreement - Arabic ,   Repatriation Repayment and Privacy Agreement - French ,   Repatriation Repayment and Privacy Agreement - Russian ,   Repatriation Repayment and Privacy Agreement - Simplified Chinese ,   Repatriation Repayment and Privacy Agreement - Spanish ,   Repatriation Repayment and Privacy Agreement - Traditional Chinese
Repatriation State Contact List
Repatriation Training and Technical Assistance Request Form 1 Repatriation Training and Technical Assistance Request Form
Routine Repatriation Reimbursement Request RR-04, RR-04, RR-04, RR-04, RR-04, RR-04, RR-04 Routine Repatriation Reimbursement Request ,   Routine Repatriation Reimbursement Request - Arabic ,   Routine Repatriation Reimbursement Request - French ,   Routine Repatriation Reimbursement Request - Russian ,   Routine Repatriation Reimbursement Request - Simplified Chinese ,   Routine Repatriation Reimbursement Request - Spanish ,   Routine Repatriation Reimbursement Request - Traditional Chinese
Temporary Assistance Extension Request RR-07, RR-07, RR-07, RR-07, RR-07, RR-07, RR-07 Temporary Assistance Extension Request ,   Temporary Assistance Extension Request - Arabic ,   Temporary Assistance Extension Request - French ,   Temporary Assistance Extension Request - Russian ,   Temporary Assistance Extension Request - Simplified Chinese ,   Temporary Assistance Extension Request - Spanish ,   Temporary Assistance Extension Request - Traditional Chinese

  Total Request 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 5,140 2,535 0 2,550 55 0
Annual Time Burden (Hours) 1,470 802 0 613 55 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This request is for additional data collection under OMB #0970-0474 to collect data to support new emergency repatriation grants and the provision of training and technical assistance. We are also requesting to extend approval of the currently approved forms without changes.

$212,612
No
    Yes
    Yes
No
No
No
No
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.
11/27/2023


© 2024 OMB.report | Privacy Policy