Crisis Assistance Request Form - (Dept. of State)

Forms and Documents

Document Name	Status
Crisis Assistance Request Form - (Dept. of State) Form and Instruction	Modified
Change Required 1405-0259.docx Justification for No Material/Nonsubstantive Change	2025-06-24
CACMS Privacy Act Statement (002).docx Supplementary Document	2023-06-28
30 Day FRN.pdf Supplementary Document	2023-06-28
2022-22211.pdf Supplementary Document	2023-06-28
Crisis Form - Legal Authorities (2-28-22) - Copy.docx Supplementary Document	2023-06-28
Supporting Statement - Generic Online form (final) (28-jun) (004).docx Supporting Statement A	2023-06-28

IC Document Collections

IC ID	Document Title	Status
261711	Crisis Assistance Request Form - (Dept. of State) Form and Instruction	Modified

ICR Details

OMB Control No: 1405-0259	ICR Reference No: 202506-1405-002
Status: Active	Previous ICR Reference No: 202306-1405-004
Agency/Subagency: STATE/AFA	Agency Tracking No:
Title: Crisis Assistance Request Form - (Dept. of State)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/24/2025
	Date Received in OIRA: 06/24/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	09/30/2026	09/30/2026
Responses	120,000	0	120,000
Time Burden (Hours)	10,000	0	10,000
Cost Burden (Dollars)	243,600	0	243,600

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Abstract: The purpose of the collection is to enable the Department of State to better identify and communicate with U.S. citizens and Lawful Permanent Residents (LPRs) who may need consular assistance during a crisis overseas.

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Authorizing Statute(s): EO: EO 12656 Name/Subject of EO: Assignment of emergency preparedness responsibilities
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 62172	10/13/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 41462	06/26/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Crisis Assistance Request Form - (Dept. of State)	NA	Crisis Assistance Request Form

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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	120,000	120,000	0	0	0	0
Annual Time Burden (Hours)	10,000	10,000	0	0	0	0
Annual Cost Burden (Dollars)	243,600	243,600	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: See supporting statement.

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Annual Cost to Federal Government: $0

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

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Common Form ICR:  No

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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: 06/24/2025

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