Supporting Statement A - OHSEPR Repat Forms PTE TTA_0970-0474_CLEAN_Nov152023

U.S. Repatriation Program Forms

OMB Information Collection Request

0970 - 0474

Supporting Statement Part A - Justification

November 2023

Type of Request: Revision

Submitted By:

Office of Human Services Emergency Preparedness and Response

Administration for Children and Families

U.S. Department of Health and Human Services

1. Circumstances Making the Collection of Information Necessary

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 (PTE). OHSEPR is proposing six new forms to support these activities.

2. Purpose and Use of the Information Collection

OHSEPR uses the information collected to conduct both emergency and routine repatriation. The eight existing forms allow OHSEPR to conduct Program operations regarding: 1) determining a repatriate’s eligibility for temporary assistance 2) granting extensions for temporary assistance beyond the 90-day eligibility period 3) collecting repatriation loans from repatriates and to grant loan waivers and deferrals 4) reimbursing states and service providers for temporary assistance provided to eligible repatriates and 5) pre-approving states’ costs for emergency repatriation.

The six new forms will allow OHSEPR to gather information about the states’ work plans and budget estimates for the emergency repatriation planning, training, and exercise funding. The forms will also allow OHSEPR to provide targeted and tailored training and technical assistance and contact states for repatriation cases and emergency repatriation activation.

3. Use of Improved Information Technology and Burden Reduction

All of the forms can be submitted electronically via e-mail. The two training and technical assistance forms and the state contact list may be completed via an online portal.

OHSEPR is considering reducing the burden by making the original eight forms fillable online. If OHSEPR determines this change is appropriate and feasible, it will submit a non-substantive change request to reflect the change in data collection mode and any adjustments to estimated time to complete the collections. We do not anticipate this change would impact the content, purpose, or use of the forms.

4. Efforts to Identify Duplication and Use of Similar Information

OHSEPR operates the only U.S. Repatriation Program. Therefore, similar data is not available and there is no duplication of effort.

5. Impact on Small Businesses or Other Small Entities

This information collection does not impact small business or other small entities.

6. Consequences of Collecting the Information Less Frequently

Not collecting this information or collecting the information less frequently would impact the ability of OHSEPR to conduct Program operations in a timely and efficient manner.

Without updated state contact information for routine and emergency repatriation, there may be delays in the processing and provision of temporary assistance to repatriates. This would also impact emergency repatriation operation activation.

7. Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

OHSEPR does not have special circumstances relating to these guidelines.

8. Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency

In accordance with the Paperwork Reduction Act of 1995 (Pub. L. 104-13) and Office of Management and Budget (OMB) regulations at 5 CFR Part 1320 (60 FR 44978, August 29, 1995), ACF published a notice in the Federal Register announcing the agency’s intention to request an OMB review of this information collection activity. This notice was published on March 14, 2023, Volume 88, Number 49, page 15728, and provided a sixty-day period for public comment. We did not receive comments.

9. Explanation of Any Payment or Gift to Respondents

Respondents do not receive any compensation for completing these forms.

10. Assurance of Confidentiality Provided to Respondents

The Repatriation Repayment and Privacy Agreement form (RR-05) includes a Privacy Act Statement that is in accordance with Program regulations 45 CFR 211.14 and 45 CFR 212.9. The Privacy Act Statement authorizes the Program to collect personally identifiable information (PII) on the RR-05 as well as the following forms: Emergency Repatriation Eligibility Application (RR-01), Loan Waiver and Deferral Application (RR-03), Routine Repatriation Reimbursement Request (RR-04), and Temporary Assistance Extension Request (RR-07).

The Privacy Statement also authorizes the Program to disclose repatriates’ PII to other Federal and state agencies, grantees, service providers, contractors, or private organizations, if necessary for HHS to carry out its responsibilities under 42 U.S.C. 1313 and 24 U.S.C. Sections 321 - 329, or to enable another Federal agency to carry out any functions related to a repatriate’s return from a foreign country to the United States, or as otherwise expressly authorized by appropriate HHS staff.

The HHS system of records notice covering the U.S. Repatriation Program is OHSEPR Repatriation and Disaster Human Services Case Management Records 09–80–0389 (88 FR 63109).

For the six new forms, OHSEPR will keep the information private to the extent permitted by law.

11. Justification for Sensitive Questions

The Repatriation Repayment and Privacy Agreement (Form RR-05) has voluntary demographic questions regarding race, ethnicity, marital status, gender, primary language, veteran status, disabilities, highest level of education, and annual household income. These questions align with Executive Order 13985 (Advancing Racial Equity and Support for Underserved Communities Through the Federal Government).

For the six new forms, there are no sensitive questions.

12. Estimates of Annualized Burden Hours and Costs

Information Collection Title	Annual Number of Respondents	Annual Number of Responses Per Respondent	Average Burden Hours Per Response	Annual Burden Hours	Average Hourly Wage	Total Annual Cost
Emergency Repatriation Eligibility Application	1,000	1	.5	500	$10.43	$5,215.00
Emergency Repatriation Reimbursement Request	10	1	.3	3	$61.88	$185.64
Loan Waiver and Deferral Application	100	1	.5	50	$10.43	$521.50
Routine Repatriation Reimbursement Request	25	10	.3	75	$61.88	$4,641.00
Repatriation Repayment and Privacy Agreement	800	1	.17	136	$10.43	$1,418.48
Refusal of Temporary Assistance	300	1	.05	15	$10.43	$156.45
Temporary Assistance Extension Request	25	1	.3	8	$61.88	$495.04
Emergency Repatriation Request for Cost Approval and Federal Support	5	10	.3	15	$61.88	$928.20
PTE – Project Narrative	55	1	.5	28	$61.88	$1,732.64
PTE – Annual Workplan	55	1	1	55	$61.88	$3,403.40
PTE – Budget and Budget Narrative	55	1	1	55	$61.88	$3,403.40
Repatriation State Contact List	220	2	.25	110	$61.88	$6,806.80
Repatriation Training and Technical Assistance Request Form	500	2	.25	250	$61.88	$15,470.00
Repatriation Post-Training Survey	1000	1	.17	170	$61.88	$10,519.60
Estimated Annual Burden Total:				1,470	Estimated Annual Cost Total:	$54,897.15

Annual Burden Estimates

Previously Approved Forms

There are no changes proposed the previously approved forms under this information collection and based on experiences to date, burden estimates have not changed. The respondent numbers are based on actual numbers of repatriates assisted during routine and emergency repatriations. The average burden hours per response are estimates based on federal employees’ experience with filling out the forms.

New Forms

The estimated number of respondents has been estimated based on the number of states and territories with repatriation agreements and OHSEPR’s past trainings. The average burden hours per response are estimates based on federal employees’ experience with filling out the forms.

Annual Cost Estimates

The annual cost estimate is $54,897.15. This number was estimated using the following calculation:

Previously Approved Forms

Repatriates are likely to complete the following four forms listed in the table above: Emergency Repatriation Eligibility Application, Loan Waiver and Deferral Application, Repatriation Repayment and Privacy Agreement, and Refusal of Temporary Assistance. Some repatriates are employed and many are unemployed. Therefore, their wage is calculated as the average minimum wage among the states in 2023 ($10.43).

Social Workers will complete the following forms: Emergency Repatriation Reimbursement Request, Routine Repatriation Reimbursement Request, Temporary Assistance Extension Request, and Emergency Repatriation Request for Cost Approval and Federal Support. The cost to respondents was calculated using the Bureau of Labor Statistics (BLS) job code for Social Workers [21-1029] and wage data from May 2022, which is $30.94 per hour. To account for fringe benefits and overhead, the hourly rate ($30.94) is multiplied by two, which is $61.88. https://www.bls.gov/oes/current/oes_stru.htm

New Forms

Social workers are likely to complete all the forms listed in the table above. The cost to respondents was calculated using the Bureau of Labor Statistics (BLS) job code for Social Workers [21-1029] and wage data from May 2022, which is $30.94 per hour. To account for fringe benefits and overhead, the hourly rate ($30.94) is multiplied by two, which is $61.88. https://www.bls.gov/oes/current/oes_stru.htm

13. Estimates of Other Total Annual Cost Burden to Respondents and Record Keepers

The total annual cost for recordkeeping is $8,000 for the grantee’s database.

There is no additional burden for the planning, training, and exercise forms.

14. Annualized Cost to the Federal Government

Current Forms

The January 2023 hourly wage for a GS 14 step 1 employee is $63.43. To account for fringe benefits and overhead, the hourly rate ($63.43) is multiplied by two, which is $126.86. The number of hours for a federal employee to analyze, evaluate, summarize and/or report on the collected information is 766 hours. Therefore, the total for ACF staff is $126.86 times 766 hours or $97,174.76.

Also, the social workers bill their staff time for filling out the forms (see number 12 - $6,249.88) to the federal government (the U.S. Repatriation Program).

In addition, the U.S. Repatriation Program grantee assists in the collection of information by helping states and repatriates complete the forms and analyzing information. The average hourly rate for grantee staff is $33.33. To account for fringe benefits and overhead, the hourly rate ($33.33) is multiplied by two, which is $66.66. The annual number of hours the grantee assists in the collection of information is 1344. The total for grantee staff is $66.66 times 1344 which is $89,591.04.

Therefore, the estimate of annualized cost to the federal government is $97,174.76 plus $6,249.88 plus $89,591 or $193,015.68.

New Forms

The January 2023 hourly wage for a GS 14 step 1 employee is $63.43. To account for fringe benefits and overhead, the hourly rate ($63.43) is multiplied by two, which is $126.86. The number of hours for a federal employee to analyze, evaluate, summarize and/or report on the collected information is 110 hours. Therefore, the total for ACF staff is $126.86 times 110 hours or $13,954.60.

The contract support includes an analyst with an hourly rate of $35.00 and fringe of $14.49, total of $49.49. The number of hours to review, analyze, and report on the TA requests form, training survey form, and state coordinator list is 114 hours. Therefore, the total for the contract support is $49.49 times 114 hours or $5,641.86.

Therefore, the estimate of annualized cost to the federal government is $13,954.60 plus $5,641.86 or $19,596.46.

Total

The total annualized cost to the federal government for currently approved forms and the new forms is $212,612.14.

15. Explanation for Program Changes or Adjustments

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.

16. Plans for Tabulation and Publication and Project Time Schedule

The results of the information collection will not be published.

17. Reason(s) Display of OMB Expiration Date is Inappropriate

OHSEPR is not requesting to not display the OMB expiration date.

18. Exceptions to Certification for Paperwork Reduction Act Submissions

No exceptions are necessary for this information collection.