Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Case Coordinator Questionnaire (Form M-13E) - Recordkeeping Modified 32 32 0 Form and Instruction Form M-13E
Case Coordinator Questionnaire (Form M-13E) - Respondents Modified 108 108 0 Form and Instruction Form M-13E
Checklist for a Child-Friendly Environment (Form M-4A to M4B) Modified 2592 648 0 Form and Instruction Form M-4A
Form and Instruction Form M-4B
Corrective Action Report (Form M-1) - Recordkeeping Modified 100 2200 0 Form and Instruction M-1
Corrective Action Report (Form M-1) - Respondents Modified 108 540 0 Form and Instruction M-1
FFS Compliance and Safety Site Visit Report (Form M-3A) - Recordkeeping Removed 0 0 0 Form and Instruction Form M-3A
FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents Modified 2592 2592 0 Form and Instruction Form M-3A
Foster Home On Site Monitoring Checklist (Form M-9B) Removed 0 0 0 Form and Instruction Form M-9
HS/PRS Site Visit Guide (Form M-7E) - Recordkeeping Modified 8 168 0 Form and Instruction Form M-7E
HS/PRS Site Visit Guide (Form M-7E) - Respondents Modified 30 180 0 Form and Instruction Form M-7E
Home Study and Post-Release Services Case File Checklist (Form M-8C) - Recordkeeping Removed 0 0 0 Form and Instruction Form M-8C
Home Study and Post-Release Services Case File Checklist (Form M-8C) - Respondents Removed 0 0 0 Form and Instruction Form M-8C
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping Modified 24 24 0 Form and Instruction Form M-13B
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents Modified 90 90 0 Form and Instruction Form M-13B
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping Modified 8 4 0 Form and Instruction Form M-13A
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents Modified 30 30 0 Form and Instruction Form M-13A
Home Study and Post-Release Services Personnel File Checklist (Form M-10C) Modified 24 24 0 Form and Instruction Form M-10C
Incident Reviews (Forms M-5A to M-5B) Modified 65 97 0 Form and Instruction Form M-5A
Form and Instruction Form M-5B
LTFC Monitoring and LTFC Remote Monitoring Notes (Forms M-6C to M-6D) Removed 0 0 0 Form and Instruction Form M-6C
Form and Instruction Form M-6D
LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Recordkeeping Modified 4 84 0 Form and Instruction Form M-7C
Form and Instruction Form M-7D
LTFC Site Visit and LTFC Remote Monitoring Site Visit Guides (Forms M-7C to M-7D) - Respondents Modified 15 90 0 Form and Instruction Form M-7C
Form and Instruction Form M-7D
Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping Modified 28 28 0 Form and Instruction Form M-13C
Legal Service Provider Questionnaire (Form M-13C) - Respondents Modified 93 93 0 Form and Instruction Form M-13C
Long Term Foster Care Client Questionnaire (M-12C) - Recordkeeping Modified 20 10 0 Form and Instruction Form M-12C
Long Term Foster Care Client Questionnaire (M-12C) - Respondents Modified 75 38 0 Form and Instruction Form M-12C
Long Term Foster Care File Checklist (Form M-8B) - Recordkeeping Removed 0 0 0 Form and Instruction Form M-8B
Long Term Foster Care File Checklist (Form M-8B) - Respondents Removed 0 0 0 Form and Instruction Form M-8B
Long Term Foster Care Foster Parent Checklist (Form M-10D) Modified 8 4 0 Form and Instruction Form M-10D
Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping Modified 8 6 0 Form and Instruction Form M-11O
Long Term Foster Care Foster Parent Questionnaire (form M-11O) - Respondents Modified 30 23 0 Form and Instruction Form M-11O
Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping Modified 4 4 0 Form and Instruction Form M-11M
Long Term Foster Care Home Finder Questionnaire (Form M-11M) - Respondents Modified 15 15 0 Form and Instruction Form M-11M
Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping Modified 4 4 0 Form and Instruction Form M-11N
Long Term Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents Modified 15 15 0 Form and Instruction Form M-11N
Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping Modified 4 3 0 Form and Instruction Form M-13D
Long Term Foster Care Legal Service Provider Questionnaire (Form M-13D) - Reporting Modified 15 11 0 Form and Instruction Form M-13D
Monitoring Schedule (Form M-15) Modified 1 0 0 Form and Instruction Form M-15
Monitoring Visit (Form M-14) Modified 32 16 0 Form and Instruction Form M-14
Monitoring and Remote Monitoring Notes (Forms M-6A to M-6B) Removed 0 0 0 Form and Instruction Form M-6A
Form and Instruction Form M-6B
On Site Monitoring Checklist (Form M-9A) Removed 0 0 0 Form and Instruction Form M-9A
Out-of-Network Site Visit Report (Form M-3B) Modified 120 120 0 Form and Instruction Form M-3B
Personnel File Checklist (Form M-10A) Modified 124 124 0 Form and Instruction Form M-10A
Post-Release Services Home Observation (Form M-9C) Removed 0 0 0 Form and Instruction Form M-9C
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping Modified 216 216 0 Form and Instruction Form M-11A
Form and Instruction Form M-11B
Form and Instruction Form M-11C
Form and Instruction Form M-11D
Form and Instruction Form M-11E
Form and Instruction Form M-11F
Form and Instruction Form M-11G
Form and Instruction Form M-11H
Form and Instruction Form M-11I
Form and Instruction Form M-11J
Form and Instruction Form M-11K
Program Staff Questionnaires (Form M-11A-K) - Respondents Modified 756 756 0 Form and Instruction Form M-11A
Form and Instruction Form M-11B
Form and Instruction Form M-11C
Form and Instruction Form M-11D
Form and Instruction Form M-11E
Form and Instruction Form M-11F
Form and Instruction Form M-11G
Form and Instruction Form M-11H
Form and Instruction Form M-11I
Form and Instruction Form M-11J
Form and Instruction Form M-11K
Secure Client Questionnaire (Form M-12D) - Recordkeeping Modified 2 1 0 Form and Instruction Form M-12D
Secure Client Questionnaire (Form M-12D) - Respondents Modified 5 3 0 Form and Instruction Form M-12D
Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping Modified 0 0 0 Form and Instruction Form M-11L
Secure Detention Officer Questionnaire (Form M-11L) - Respondents Modified 1 1 0 Form and Instruction Form M-11L
Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Recordkeeping Removed 0 0 0 Form and Instruction Form M-8D
Secure and Staff Secure Addendum to Case File Checklist (Form M-8D) - Respondents Removed 0 0 0 Form and Instruction Form M-8D
Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Recordkeeping Modified 28 812 0 Form and Instruction Form M-7A
Form and Instruction Form M-7B
Site Visit and Remote Monitoring Site Visit Guides (Forms M-7A to M-7B) - Respondents Modified 93 1209 0 Form and Instruction Form M-7A
Form and Instruction Form M-7B
Supplement to Personnel File Checklist (Form M-10B) Modified 216 216 0 Form and Instruction Form M-10B
UAC Case File Checklist (Form M-8A) - Recordkeeping Removed 0 0 0 Form and Instruction Form M-8A
UAC Case File Checklist (Form M-8A) - Respondents Removed 0 0 0 Form and Instruction Form M-8A
UC Questionnaires (Forms M-12A-B, E) - Recordkeeping Modified 132 66 0 Form and Instruction Form M-12A
Form and Instruction Form M-12B
Form and Instruction Form M-12E
Form and Instruction Form M-12As
Form and Instruction Form M-12Bs
Form and Instruction Form M-12Es
UC Questionnaires (Forms M-12A-B, E) - Respondents Modified 460 230 0 Form and Instruction Form M-12A
Form and Instruction Form M-12B
Form and Instruction Form M-12E
Form and Instruction Form M-12As
Form and Instruction Form M-12Bs
Form and Instruction Form M-12Es
Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping Modified 2 56 0 Form and Instruction Form M-7F
Voluntary Agency Site Visit Guide (Form M-7F) - Respondents Modified 5 40 0 Form and Instruction Form M-7F
Total burden requested under this ICR: 8342 11031 0  
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