Routine Repatriation Reimbursement Request

U.S. Repatriation Program Forms

Documents and Forms

Document Name Document Type
Form RR-04 Routine Repatriation Reimbursement Request Form and Instruction
RR-04 Routine Repatriation Reimbursement Request RR-04 Routine Repatriation Reimbursement Request (1).docx Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Arabic RR-04 Routine Repatriation Reimbursement Request - STANDARD_ar 508.pdf Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - French RR-04 Routine Repatriation Reimbursement Request - STANDARD_fr 508.pdf Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Russian RR-04 Routine Repatriation Reimbursement Request - STANDARD_ru 508.pdf Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Simplified RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_cn 508.pdf Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Spanish RR-04 Routine Repatriation Reimbursement Request - STANDARD_es_508.pdf Form and Instruction
RR-04 Routine Repatriation Reimbursement Request - Traditional RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_TW 508.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Routine Repatriation Reimbursement Request	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request	RR-04 Routine Repatriation Reimbursement Request (1).docx	Yes	Yes	Fillable Printable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Arabic	RR-04 Routine Repatriation Reimbursement Request - STANDARD_ar 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - French	RR-04 Routine Repatriation Reimbursement Request - STANDARD_fr 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Russian	RR-04 Routine Repatriation Reimbursement Request - STANDARD_ru 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Simplified Chinese	RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_cn 508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Spanish	RR-04 Routine Repatriation Reimbursement Request - STANDARD_es_508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	RR-04	Routine Repatriation Reimbursement Request - Traditional Chinese	RR-04 Routine Repatriation Reimbursement Request - STANDARD_zh_TW 508.pdf	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: OHSEPR Repatriation and Disaster Human Services Case Management Records 09–80–0389	FR Citation: 88 FR 63109

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.