U.S. Repatriation Program Forms

OMB 0970-0474

This information is being requested in order to carry out the functions of the U.S. Repatriation Program. This program is authorized by Section 1113 of the Social Security Act (42 U.S.C. § 1313) and the assistance provided to mentally ill repatriates found under 24 U.S.C. §§ 321 - 329. This program also provides services under emergency and group repatriations which are authorized under Section 1113 and by the extension of the Executive Order (E.O.) precedent, E.O. 12656 (53 CFR 47491). General program regulations are found under 45 CFR 211 & 212. These laws and regulations require HHS to obtain specific information to determine eligibility for HHS repatriation, to provide services to eligible repatriates, to reimburse states for services provided and to collect repatriation loans from repatriates. This collection of information was originally approved on March 4, 2016. This current request is for an extension with no changes to the data collection elements. Forms were updated to make minor grammatical edits and to update phone numbers and addresses to be current.

The latest form for U.S. Repatriation Program Forms expires 2022-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 Repatriation Training and Technical Assistance Request Form Form
Form RR-08 Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction
Form RR-07 Temporary Assistance Extension Request Form and Instruction
Form RR-06 Refusal of Temporary Assistance Form and Instruction
Form RR-05 Repatriation Repayment and Privacy Agreement Form and Instruction
Form RR-04 Routine Repatriation Reimbursement Request Form and Instruction
Form RR-03 Loan Waiver and Deferral Application Form and Instruction
Form RR-02 Emergency Repatriation Reimbursement Request Form and Instruction
Form RR-01 Emergency Repatriation Eligibility Application Form and Instruction
Supporting Statement A - OHSEPR Repat Forms PTE TTA_0970-0474_CLEAN_Nov152023.docx Supporting Statement A
Repatriation Post-Training Survey Other-Survey
Repatriation Training and Technical Assistance Request Form Form
Repatriation State Contact List Other-Contact List
Planning, Training, and Exercise – Budget and Budget Narrative Other-Narrative
Planning, Training, and Exercise – Annual Workplan Other-Workplan
Planning, Training, and Exercise – Project Narrative Other-Narrative
Emergency Repatriation Request for Cost Approval and Federal Support Form and Instruction
Temporary Assistance Extension Request Form and Instruction
Refusal of Temporary Assistance Form and Instruction
Repatriation Repayment and Privacy Agreement Form and Instruction
Routine Repatriation Reimbursement Request Form and Instruction
Loan Waiver and Deferral Application Form and Instruction
Emergency Repatriation Reimbursement Request Form and Instruction
Emergency Repatriation Eligibility Application Form and Instruction

All Historical Document Collections

202311-0970-008 Approved with change	Revision of a currently approved collection	2023-11-27
202304-0970-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-05-01
202204-0970-004 Approved without change	Revision of a currently approved collection	2022-04-12
201903-0970-002 Approved without change	Extension without change of a currently approved collection	2019-03-29
201510-0970-006 Approved with change	New collection (Request for a new OMB Control Number)	2015-11-18

OMB Details

Emergency and Group Processing

Federal Enterprise Architecture: Community and Social Services - Social Services

Form 1

Emergency and Group Processing Form

Fillable Printable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.