RR-05 Repatriation Repayment and Privacy Agreement
This form is for the repatriate to accept temporary assistance under the U.S. Repatriation Program, agree to repay HHS for temporary assistance, and allow HHS to share personal information for benefits purposes.
This form is available in the following languages: English, Arabic, Chinese Simplified, Traditional Chinese, Farsi, French, German, Haitian Creole, Hebrew, Kurdish, Portuguese (Brazil), Spanish, Turkish, Russian, and Tagalog. The form is located: RR-05 Repatriation Repayment and Privacy Agreement.
The instructional video on how to complete form RR-05 is also available in Spanish.
Vea el video Cómo completo el Formulario de Pago de Repatriación y Acuerdo de Privacidad (RR-05) para un tutorial sobre cómo completar este formulario.