Evacuee Manifest and Promissory Note

OMB 1405-0211

The DS 5528, Evacuee Manifest and Promissory Note, is used to document the evacuation of persons from abroad when their lives are endangered by war, civil unrest, or natural disaster; document issuance of a crisis evacuation loan; to obtain a Privacy Act waiver to share information about the welfare of a citizen or lawful permanent resident with designated persons; and to facilitate debt collection.

The latest form for Evacuee Manifest and Promissory Note expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DS-5528 Evacuee Manifest and Promissory Note Form and Instruction
Form DS-5528 Evacuee Manifest and Promissory Note Form and Instruction
Form DS-5528 Evacuee Manifest and Promissory Note Form and Instruction
Form DS-5528 Evacuee Manifest and Promissory Note Form and Instruction
ds5528 - DRAFT - 06-06-2024.pdf Justification for No Material/Nonsubstantive Change
ds5528 - DRAFT - 06-06-2024.pdf Justification for No Material/Nonsubstantive Change
Justification for Non-substantive change.docx Justification for No Material/Nonsubstantive Change
Justification for Non-substantive change.docx Justification for No Material/Nonsubstantive Change
5528 langauge.docx Supplementary Document
5528 langauge.docx Supplementary Document
2024 04 04 Answers to OIRA 2020 Questions DS 5528 Supporting Statement.docx Supplementary Document
2024 04 04 Answers to OIRA 2020 Questions DS 5528 Supporting Statement.docx Supplementary Document
2024 04 04 Supporting Statement Updated.docx Supporting Statement A
2024 04 04 Supporting Statement Updated.docx Supporting Statement A
Final Legal Authorities DS-5528.docx Supplementary Document
Final Legal Authorities DS-5528.docx Supplementary Document
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction
Evacuee Manifest and Promissory Note Form and Instruction

All Historical Document Collections

202406-1405-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-06-13
202404-1405-001 Approved without change	Reinstatement without change of a previously approved collection	2024-04-15
202007-1405-003	Revision of a currently approved collection	2020-07-31
201906-1405-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-06-26
201807-1405-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-07-11
201705-1405-003 Approved without change	Extension without change of a currently approved collection	2017-05-12
201602-1405-007 Approved with change	No material or nonsubstantive change to a currently approved collection	2016-02-12
201601-1405-005 Improperly submitted and continue	No material or nonsubstantive change to a currently approved collection	2016-01-29
201601-1405-004 Improperly submitted and continue	Revision of a currently approved collection	2016-01-28
201504-1405-001 Approved with change	Extension without change of a currently approved collection	2015-04-14
201305-1405-002 Approved with change	New collection (Request for a new OMB Control Number)	2013-05-14