View Information Collection Request (ICR) Package
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View ICR - Agency Submission
OMB Control No:
1405-0150
ICR Reference No:
202509-1405-004
Status:
Received in OIRA
Previous ICR Reference No:
202507-1405-001
Agency/Subagency:
STATE/AFA
Agency Tracking No:
Title:
Repatriation/Emergency Medical and Dietary Assistance Loan Application
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
Date Submitted to OIRA:
09/18/2025
Requested
Previously Approved
Expiration Date
06/30/2027
06/30/2027
Responses
1,459
2,918
Time Burden (Hours)
486
972
Cost Burden (Dollars)
38,830
77,660
Abstract:
The DS-3072 is an application for an emergency loan for a destitute U.S. citizen and/or dependent to return to the United States, an application for a destitute U.S. citizen abroad to receive emergency medical and dietary assistance and an application for a U.S. citizen and/or dependent and a third country or host country national to receive a loan to assist in his or her repatriation to the United States and/or to provide them with the funds needed to address their emergency medical and/or dietary needs.
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:
85 FR 28691
05/13/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 46207
07/31/2020
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
Repatriation/Emergency Medical and Dietary Assistance Loan Application
DS-3072
Repatriation/Emergency Medical and Dietary Assistance Loan Application MS Form
Repatriation/Emergency Medical and Dietary Assistance Loan Application
Old DS-3072, DS-302
Repatriation/ Emergency Medical and Dietary Assistance Loan Application
,
Repatriation/ Emergency Medical and Dietary Assistance Loan Application
Repatriation/Emergency Medical and Dietary Assistance Loan Application
DS-3072
REPATRIATION / EMERGENCY MEDICAL AND DIETARY ASSISTANCE LOAN APPLICATION
ICR Summary of Burden
Total Request
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
1,459
2,918
0
0
-1,459
0
Annual Time Burden (Hours)
486
972
0
0
-486
0
Annual Cost Burden (Dollars)
38,830
77,660
0
0
-38,830
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:
$47,228
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:
Thales Dus 202 485-6725
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:
09/18/2025
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