View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1405-0150
ICR Reference No:
201305-1405-001
Status:
Historical Active
Previous ICR Reference No:
201005-1405-005
Agency/Subagency:
STATE/AFA
Agency Tracking No:
Title:
Repatriation/Emergency Medical and Dietary Assistance Loan Application
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
06/24/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/13/2013
Terms of Clearance:
Approved for two years only due to lack of GPEA compliance. This form cannot be submitted online.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2015
36 Months From Approved
06/30/2013
Responses
1,357
0
1,176
Time Burden (Hours)
452
0
196
Cost Burden (Dollars)
86,750
0
0
Abstract:
The DS 3072 is used to provide an accurate list of U.S. citizens and non-U.S. citizens receiving repatriation/emergency medical and dietary assistance in foreign countries. The information collected will be used to process the emergency loan, facilitate reception and resettlement assistance in the United States and for debt collection. Respondents are private U.S. citizens and their dependents abroad who are destitute and in need of repatriation to the United States and/or emergency medical and dietary assistance.
Authorizing Statute(s):
US Code:
22 USC 2670
Name of Law: Responsibility of Secretary of State
US Code:
22 USC 2671
Name of Law: Emergency expenditures
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR 13742
02/28/2013
30-day Notice:
Federal Register Citation:
Citation Date:
78 FR 27469
05/10/2013
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Emergency Loan Application and Evacuation Documentation
DS-3072
Repatriation/Emergency Medical and Dietary Assistance Loan Application
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
1,357
1,176
0
0
181
0
Annual Time Burden (Hours)
452
196
0
256
0
0
Annual Cost Burden (Dollars)
86,750
0
0
86,750
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Changes in burden and costs are due to a form revision, increased number of respondents and the inclusion of Notary fees and mailing costs to the respondents.
Annual Cost to Federal Government:
$4,710,627
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Derek Rivers 202 736-9082 RiversDA@state.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/13/2013
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