Click here for the Privacy and Repayment Form (Form RR-05).
Payments should be made by check or money order payable to “DHHS/PSC/HHS/Repatriate”. Payment should be mailed to:
U.S. Department of Health and Human Services
Program Support Center (PSC-HHS)
Attention: Repatriation Collections Officer
7700 Wisconsin Avenue
Suite 8-8110D
Bethesda, MD 20857
Distribution: Original to FSA Administrator, Copy to Repatriate, Copy retained by State Agency.
Click here for the Refusal of Temporary Assistance Form (Form RR-06).
Reissued March 14, 2019, replacing June 24, 2009