View Information Collection Request (ICR) Package

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: 1405-0223	ICR Reference No: 202604-1405-003
Status: Historical Active	Previous ICR Reference No: 201912-1405-004
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Adoption Family Relief Act Refund Application
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/28/2026
	Date Received in OIRA: 04/20/2026
Terms of Clearance: OMB is reinstating this collection for a period of 3 months to allow the agency to request that the control number be formally discontinued.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	6 Months From Approved
Responses	20	0	0
Time Burden (Hours)	2	0	0
Cost Burden (Dollars)	94	0	0

Annual Cost to Federal Government: $758

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: Robert Schlicht 202 486-6685 schlichtrr@state.gov

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