DS-5528-2025

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The document is an Evacuation Application and Promissory Note from the U.S. Department of State, requiring adult applicants to provide personal information for evacuation purposes. It outlines the responsibilities and repayment obligations for U.S. citizens and non-citizens regarding evacuation costs, including terms for loan repayment, contact information, and medical conditions relevant to evacuation. The document also includes sections for consular officer use and privacy act authorization.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What happens if you refuse to evacuate?

If you are not in any of the zones or structures asked to evacuate, you may stay at home if you feel safe doing so. Be sure to have a fully stocked emergency kit, prepare your residence to weather the storm, ensure others (family or friends) know your plan and follow all preparedness messages from local officials.

What if Im not in the evacuation zone?

Stay Indoors: If you cannot evacuate, stay inside a sturdy building away from windows and doors. Use a Safe Room: If available, go to an interior room or hallway on the lowest floor, ideally a room without windows. Secure Windows and Doors: Use plywood or storm shutters to protect windows.

What to do if I cant evacuate?

If youre in an evacuation zone and lack gas, look into transportation to a shelter tomorrow, the earlier the better. See if you can get an uber, Lyft or taxi. See if local buses have the shelters on their routes. Call local info hotlines (be patient - youll be on hold awhile since lots of people need info).

Can the government make you evacuate?

Almost every year people along coastlines evacuate before hurricanes. If an official government source advises you to evacuate, do so immediately. Only when theres a serious threat to public safety is a mandatory evacuation ordered.

What happens if you cant evacuate?

Contact your local emergency management agency for assistance. Call or text 911 for immediate assistance. Your neighbors are your lifeline. Let them know if you need assistance to evacuate.

Key Facts about the Evacuation Manifest and Promissory Note Form

Mandatory Completion for Adults

Social Security Number Requirement

Medical Information Disclosure

Repayment Agreement for U.S. Citizens

Non-U.S. Citizens' Repayment Terms

Privacy Act Authorization

Estimated Burden Time

Mandatory Completion for Adults

Each adult applicant, regardless of nationality, must complete the evacuation application section of the form.

Social Security Number Requirement

Applicants are required to provide their Social Security number as part of the identification process.

Medical Information Disclosure

The form requires applicants to disclose any medical conditions or injuries that may affect their evacuation.

Repayment Agreement for U.S. Citizens

U.S. citizens must agree to repay the government for evacuation costs within 30 days, with potential interest if not paid in full within 60 days.

Non-U.S. Citizens' Repayment Terms

Non-U.S. citizens will have their repayment terms determined by their respective governments in coordination with the U.S.

Privacy Act Authorization

The form includes an optional Privacy Act authorization allowing information release to specified individuals and entities.

Estimated Burden Time

The estimated time to complete this form is approximately 20 minutes, according to the Paperwork Reduction Act statement.

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Will the US evacuate green card holders?

In general, we do not provide evacuation assistance to non-U.S. citizens. Exceptions may be made to accommodate special family circumstances, such as when a spouse or other relative of a U.S. citizen is traveling with the U.S. citizen family member.

What must be taken with you in the case of evacuation?

Emergency evacuation packing list Pack your items in crates or bags you can easily carry. Include food and water for everyone in your household. Pack a change of clothes for up to a week and personal hygiene items. Bundle up what youll need for the little ones. Dont forget your pets.

DS-5528-2025

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