Repatriation/Emergency Medical and Dietary Assistance Loan Application

OMB 1405-0150

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.

The latest form for Repatriation/Emergency Medical and Dietary Assistance Loan Application expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DS-302 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction
Form DS-3072 Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction
Justification for Change to DS 3072 - 1405-0150.docx Justification for No Material/Nonsubstantive Change
MS Forms DS-3072 Screenshots.docx Justification for No Material/Nonsubstantive Change
Justification for Non-substantive change.docx Justification for No Material/Nonsubstantive Change
Privacy Act Statement Changes-easy to read.docx Supplementary Document
2024 04 03 856 am Answers to OIRA 2020 Questions DS 3072 Supporting Statement CLEAN NO COMMENTS.docx Supplementary Document
DS-3072 Legal Authorities.doc Supplementary Document
2024 04 03 901 AM DS-3072 Supporting Statement 2020 doc Revised Clean Version NO L COMMENTS OR EDITS.docx Supporting Statement A
Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction
Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction
Repatriation/Emergency Medical and Dietary Assistance Loan Application Form and Instruction

All Historical Document Collections

202509-1405-004	No material or nonsubstantive change to a currently approved collection	2025-09-18
202507-1405-001	No material or nonsubstantive change to a currently approved collection	2025-07-01
202406-1405-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-06-13
202404-1405-003 Approved without change	Reinstatement without change of a previously approved collection	2024-04-15
202007-1405-004	Revision of a currently approved collection	2020-07-31
201906-1405-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2019-06-26
201706-1405-005 Approved without change	Extension without change of a currently approved collection	2017-06-30
201504-1405-002 Approved with change	Extension without change of a currently approved collection	2015-04-14
201305-1405-001 Approved with change	Revision of a currently approved collection	2013-05-13
201005-1405-005 Approved without change	Extension without change of a currently approved collection	2010-05-13
201003-1405-001 Withdrawn and continue	Revision of a currently approved collection	2010-03-01
200811-1405-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-11-17
200702-1405-001 Approved without change	Revision of a currently approved collection	2007-02-12
200309-1405-007 Approved without change	Extension without change of a currently approved collection	2003-09-30
200303-1405-001 Approved without change	Existing collection in use without an OMB Control Number	2003-03-21