Repatriation Repayment and Privacy Agreement

U.S. Repatriation Program Forms

Documents and Forms

Document Name Document Type
Form RR-05 Repatriation Repayment and Privacy Agreement Form and Instruction
RR-05 Repatriation Repayment and Privacy Agreement RR-05 Repatriation Repayment and Privacy Agreement - Jan2025Update - CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Repatriation Repayment and Privacy Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	RR-05	Repatriation Repayment and Privacy Agreement	RR-05 Repatriation Repayment and Privacy Agreement - Jan2025Update - CLEAN.docx		Yes	Yes	Fillable Printable

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: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	136	136
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.