View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
202204-0970-004
Status:
Historical Active
Previous ICR Reference No:
201903-0970-002
Agency/Subagency:
HHS/ACF
Agency Tracking No:
OHSEPR
Title:
U.S. Repatriation Program Forms
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/13/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/12/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2025
36 Months From Approved
06/30/2022
Responses
2,535
0
51,524
Time Burden (Hours)
802
0
9,204
Cost Burden (Dollars)
0
0
0
Abstract:
This information collection allows OHSEPR to fulfill its statutory responsibilities to provide temporary assistance to repatriates. OHSEPR uses this information collection to conduct both emergency and routine repatriation. These forms allow OHSEPR to conduct Program operations regarding: 1) determining a repatriate’s eligibility for temporary assistance 2) granting extensions for temporary assistance beyond the 90-day eligibility period 3) collecting repatriation loans from repatriates and to grant loan waivers and deferrals 4) reimbursing states and service providers for temporary assistance provided to eligible repatriates and 5) pre-approving states’ costs for emergency repatriation. OHSEPR made changes to all eight forms to ensure the information collected aligns with Program statutes and regulations as well as the purpose and use of the form. Revisions include clarifying statutory authority and general instructions on completing and submitting the forms. These changes make the forms more user friendly. OHSEPR also reduced the burden estimates to make them more accurate.
Authorizing Statute(s):
EO: EO 12656 Name/Subject of EO: Assignment of Emergency Preparedness Responsibilities
US Code:
42 USC 1313
Name of Law: Social Security Act
US Code:
24 USC 321-329
Name of Law: Hospitals and Asylums
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:
87 FR 6569
02/04/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 21662
04/12/2022
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 Repatriation Eligibility Application
1
Emergency Repatriation Eligibility Application
Emergency Repatriation Reimbursement Request
1
Emergency Repatriation Reimbursement Request
Emergency Repatriation Request for Cost Approval and Federal Support
1
Emergency Repatriation Request for Cost Approval and Federal Support
Loan Waiver and Deferral Application
1
Loan Waiver and Deferral Application
Refusal of Temporary Assistance
1
Refusal of Temporary Assistance
Repatriation Repayment and Privacy Agreement
1
Repatriation Repayment and Privacy Agreement
Routine Repatriation Reimbursement Request
1
Routine Repatriation Reimbursement Request
Temporary Assistance Extension Request
1
Temporary Assistance Extension Request
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
2,535
51,524
0
-48,989
0
0
Annual Time Burden (Hours)
802
9,204
0
-8,402
0
0
Annual Cost Burden (Dollars)
0
0
0
0
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
OHSEPR made changes to all eight forms and adjusted the burden and cost estimates to make them more accurate, based on current numbers and experiences to-date. See section A12 of the Supporting Statement for information about updates to burden estimates. In addition to updates to burden estimates as described in the Supporting Statement, the forms were uploaded in order for this submission and as such, some of the changes to burden on IC lines with ROCIS are due to shifting the order of entries.
Annual Cost to Federal Government:
$188,568
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.
Yes
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?
No
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:
04/12/2022
An official website of the United States government
The .gov means it's official.
The site is secure.
