Repatriation/Emergency Medical and Dietary Assistance Loan Application

Forms and Documents

Document Name	Status
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction	New
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction	Unchanged
MS Forms DS-3072 Screenshots.docx Justification for No Material/Nonsubstantive Change	2025-07-01
Justification for Non-substantive change.docx Justification for No Material/Nonsubstantive Change	2024-06-13
Privacy Act Statement Changes-easy to read.docx Supplementary Document	2024-04-15
2024 04 03 856 am Answers to OIRA 2020 Questions DS 3072 Supporting Statement CLEAN NO COMMENTS.docx Supplementary Document	2024-04-15
DS-3072 Legal Authorities.doc Supplementary Document	2017-06-30
2024 04 03 901 AM DS-3072 Supporting Statement 2020 doc Revised Clean Version NO L COMMENTS OR EDITS.docx Supporting Statement A	2024-04-15

IC Document Collections

IC ID	Document Title	Status
276052	Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction	New
15037	Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction	Unchanged

ICR Details

OMB Control No: 1405-0150	ICR Reference No: 202507-1405-001
Status: Received in OIRA	Previous ICR Reference No: 202406-1405-004
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: 07/01/2025

	Requested	Previously Approved
Expiration Date	06/30/2027	06/30/2027
Responses	2,918	1,459
Time Burden (Hours)	972	486
Cost Burden (Dollars)	77,660	38,830

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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.

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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

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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:
	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

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Number of Information Collection (IC) in this ICR: 2

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	DS-3072	REPATRIATION / EMERGENCY MEDICAL AND DIETARY ASSISTANCE LOAN APPLICATION

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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	2,918	1,459	0	0	1,459	0
Annual Time Burden (Hours)	972	486	0	0	486	0
Annual Cost Burden (Dollars)	77,660	38,830	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:

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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

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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: 07/01/2025

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