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:
0970-0474
ICR Reference No:
201903-0970-002
Status:
Historical Active
Previous ICR Reference No:
201510-0970-006
Agency/Subagency:
HHS/ACF
Agency Tracking No:
OHSEPR
Title:
U.S. Repatriation Program Forms
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/29/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/29/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2022
36 Months From Approved
04/30/2019
Responses
51,524
0
51,524
Time Burden (Hours)
9,204
0
9,204
Cost Burden (Dollars)
0
0
0
Abstract:
This information is being requested in order to carry out the functions of the U.S. Repatriation Program. This program is authorized by Section 1113 of the Social Security Act (42 U.S.C. § 1313) and the assistance provided to mentally ill repatriates found under 24 U.S.C. §§ 321 - 329. This program also provides services under emergency and group repatriations which are authorized under Section 1113 and by the extension of the Executive Order (E.O.) precedent, E.O. 12656 (53 CFR 47491). General program regulations are found under 45 CFR 211 & 212. These laws and regulations require HHS to obtain specific information to determine eligibility for HHS repatriation, to provide services to eligible repatriates, to reimburse states for services provided and to collect repatriation loans from repatriates. This collection of information was originally approved on March 4, 2016. This current request is for an extension with no changes to the data collection elements. Forms were updated to make minor grammatical edits and to update phone numbers and addresses to be current.
Authorizing Statute(s):
US Code:
42 USC 1313
Name of Law: Social Security Act
US Code:
24 USC 321-329
Name of Law: Hospitals and Asylums
EO: EO 12656 Name/Subject of EO: Assignment of Emergency Preparedness Responsibilities
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:
84 FR 739
01/31/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 11982
03/29/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Emergency and Group Processing
1
Emergency and Group Processing Form
Emergency and Group Repatriation
1
Emergency Repatriation Financial Form
Loan Waiver and Deferral Request Form
1
Loan Waiver and Deferral Request
Non-emergency Monthly Financial Statement Form
1
Non-emergency Monthly Financial Statement Form
Privacy and Repayment Agreement
1
Privacy and Repayment Agreement Form
Refusal of Temporary Assistance
1
Refusal of Temporary Assistance Form
State Request for Federal Support
1
State Request for Federal Support Form
Temporary Assistance Extension Request Form
1
Temporary Assistance Extension Request Form
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
51,524
51,524
0
0
0
0
Annual Time Burden (Hours)
9,204
9,204
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$40,708
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
Molly Buck 202 205-4724 mary.buck@acf.hhs.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:
03/29/2019
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