Emergency and Group Repatriation Financial Form

Form RR-02

Publication Date: January 8, 2020

This form should be completed by the state designated agency and ACF authorized support agency to request reimbursement of reasonable and allowable costs incurred as a result of (1) ACF activation of the State Emergency Repatriation Plan (SERP), or (2) ACF interagency agreement, or similar mechanism, in support of an emergency or group repatriation. By completing this form signatory confirms that identified expenditures have been made in accordance with Public Law 87-64 or Public Law 86-571, and all policies and procedures prescribed for the U.S. Repatriation Program (Program).

This form should be used as the cover sheet for financial claims requests. Reimbursement is contingent upon availability of the U.S. Repatriation Program funds.

If any item claimed as expenditure is paid and later canceled, voided, or refunded (e.g. not needed or changed in amount) it should be reported immediately to ACF. The state or support agency should provide a brief explanation of the situation. In addition, the state must issue a check or authorized form of payment to the U.S. Government designated agency. Fiscal records supporting expenditures, including vendor bills, invoices, vouchers receipts, and cleared checks will be maintained by the state and/or agency and identified for audit purposes.

When to submit a financial claim: Claims are to be submitted within 30-day after the ACF notice to close the Emergency Repatriation Center is received, or upon successful completion of established ACF agreement (e.g. IAA). Signed form with supporting documentation should be sent to the designated ACF staff or ACF designee. If the claim cannot be submitted within the 30-day period, the state or support agency should submit timely notification to ACF in writing providing an explanation and requesting an extension. Requests should be sent to the above address or via e-mail to the designated ACF staff. This prompt notification is critical and necessary in order to ensure that the claim will be considered when received.

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