Repatriation State Contact List

OMB Control No:	0970-0474
Expiration Date:
Estimated Burden:	30 minutes

U.S. Repatriation Program – State Contact List

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to determine eligibility for temporary assistance under the U.S. Repatriation Program during an emergency repatriation. Public reporting burden for this collection of information is estimated to average 0.5 hours per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is required to obtain a benefit (42 U.S.C. Section 1313). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0474 and the expiration date is xx/xx/xxxx. If you have any comments on this collection of information, please contact the U.S. Repatriation Program, 330 C St. SW, Washington, D.C. 20201.

Background

The U.S. Repatriation Program was established in 1935 under Section 1113 of the Social Security Act (42 U.S.C. § 1313) to provide temporary assistance to U.S. citizens and their dependents who have been identified by the U.S. Department of State as having returned, or been brought from a foreign country, to the United States because of destitution, illness, war, threat of war, or a similar crisis, and because they are without resources immediately accessible to meet their needs.

Section I. Lead Federal Agency

ACF Office of Human Services Emergency Preparedness and Response

The U.S. Repatriation Program is managed by the U.S. Department of Health and Human Services’ Administration for Children and Families’ Office of Human Services Emergency Preparedness and Response (OHSEPR). OHSEPR relies on its state and territorial partners to assist U.S. citizens during both routine and emergency repatriation operations.

U.S. Repatriation Program Policy

Policy guidance on routine repatriation operations is available in OHSEPR’s Routine Repatriation Information Memorandum. Policy guidance on routine repatriation operations is available in OHSEPR’s Emergency Repatriation Information Memorandum.

U.S. Repatriation Program Contacts

Please contact OHSEPR-Repatriation@acf.hhs.gov for questions about program and policy operations. Please contact OHSEPR-AF@acf.hhs.gov for financial reimbursements.

Section II. State

State of______________________________ Date Completed:

Section III. Routine Repatriation State Contact Information

Every day, U.S. citizens are repatriated to the United States from foreign countries. Once OHSEPR determines eligibility for temporary assistance via the U.S. Repatriation Program, OHSEPR and its grantee coordinate with state human services departments in a repatriate’s state of final destination to support the repatriate in the United States.

To ensure that OHSEPR has current state contact information, please identify leads and back ups for case management and financial reimbursement.

State Lead Agency for Routine Repatriation

Department/Agency Name:

Department/Agency Mailing Address:

State Non-Emergency Repatriation Coordinators

Lead for Case Management

Name: Position:

Agency: Address:

Desk Phone: Mobile Phone:

Email:

Back up for Case Management

Name: Position:

Agency: Address:

Desk Phone: Mobile Phone:

Email:

Lead for Financial Reimbursements

Name: Position:

Agency: Address:

Email:

Back up for Financial Reimbursements

Name: Position:

Agency: Address:

Email:

Section IV. Emergency Repatriation State Contact Information

In the United States, OHSEPR leads all federal emergency repatriation planning and operations conducted as part of the U.S. Repatriation Program. OHSEPR can work with states to develop State Emergency Response Plans and to conduct planning, training, and exercise activities in support of the U.S. Repatriation Program. OHSEPR also determines when to initiate and conclude emergency repatriation operations and reimburses states for costs that OHSEPR determines are reasonable, allowable, and allocable expenses associated with emergency repatriation operations.

To ensure that OHSEPR has current state contact information, please identify leads and backups for planning, training, and exercises; activations and operations, case management, and financial reimbursement.

State Lead Agency for Emergency Repatriation

Department/Agency Name:

Department/Agency Mailing Address:

State Emergency Repatriation Coordinators

Lead for Planning, Training, and Exercises

Name: Position:

Agency: Address:

Email:

Backup for Planning, Training, and Exercises

Name: Position:

Agency: Address:

Email:

Lead for Activation and Operations

Name: Position:

Agency: Address:

Desk Phone: Mobile Phone:

Email:

Backup for Activation and Operations

Name: Position:

Agency: Address:

Desk Phone: Mobile Phone:

Email:

Lead for Case Management

Name: Position:

Agency: Address:

Desk Phone: Mobile Phone:

Email:

Back up for Case Management

Name: Position:

Agency: Address:

Desk Phone: Mobile Phone:

Email:

Lead for Financial Reimbursements

Name: Position:

Agency: Address:

Email:

Back up for Financial Reimbursements

Name: Position:

Agency: Address:

Email: