Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Case Coordinator Questionnaire (Form M-13E) - Recordkeeping Unchanged 32 32 0 Form and Instruction Form M-13E
Case Coordinator Questionnaire (Form M-13E) - Respondents Unchanged 131 131 0 Form and Instruction Form M-13E
Checklist for a Child-Friendly Environment (Form M-4a to M-4B) Unchanged 3144 786 0 Form and Instruction Form M-4A
Form and Instruction Form M-4B
Corrective Action Report (Form M-1) - Recordkeeping Unchanged 100 2200 0 Form and Instruction M-1
Corrective Action Report (Form M-1) - Respondents Unchanged 105 524 0 Form and Instruction M-1
FFS Site Visit Form (Form M-3A) - Respondents Modified 3144 3144 0 Form and Instruction Form M-3A
Foster Care Client Questionnaire (M-12C) - Recordkeeping Unchanged 20 10 0 Form and Instruction Form M-12C
Foster Care Client Questionnaire (M-12C) - Respondents Unchanged 88 44 0 Form and Instruction Form M-12C
Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping Unchanged 8 4 0 Form and Instruction Form M-10D
Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping Unchanged 8 6 0 Form and Instruction Form M-11O
Foster Care Foster Parent Questionnaire (form M-11O) - Respondents Unchanged 35 26 0 Form and Instruction Form M-11O
Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping Unchanged 4 4 0 Form and Instruction Form M-11M
Foster Care Home Finder Questionnaire (Form M-11M) - Respondents Unchanged 18 18 0 Form and Instruction Form M-11M
Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping Unchanged 4 4 0 Form and Instruction Form M-11N
Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents Unchanged 18 18 0 Form and Instruction Form M-11N
Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping Unchanged 4 3 0 Form and Instruction Form M-13D
Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents Unchanged 18 14 0 Form and Instruction Form M-13D
Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping Unchanged 4 84 0 Form and Instruction Form M-7C
Foster Care Site Visit Guide (Forms M-7C) - Respondents Unchanged 18 108 0 Form and Instruction Form M-7C
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping Unchanged 24 24 0 Form and Instruction Form M-13B
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents Unchanged 90 90 0 Form and Instruction Form M-13B
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping Unchanged 8 4 0 Form and Instruction Form M-13A
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents Unchanged 30 30 0 Form and Instruction Form M-13A
Home Study and Post-Release Services Personnel File Checklist (Form M-10C) - Recordkeeping Unchanged 24 24 0 Form and Instruction Form M-10C
Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping Unchanged 4 84 0 Form and Instruction Form M-7E
Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents Unchanged 30 180 0 Form and Instruction Form M-7E
Incident Reviews (Forms M-5A to M-5B) Unchanged 79 118 0 Form and Instruction Form M-5A
Form and Instruction Form M-5B
Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping Unchanged 13 151 0 Form and Instruction Form M-6E-UF
Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping Unchanged 13 365 0 Form and Instruction Form M-7G
Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents Unchanged 3 45 0 Form and Instruction Form M-7G
Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping Unchanged 54 54 0 Form and Instruction Form M-10E
Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping Unchanged 384 384 0 Form and Instruction Form M-17B
Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent Unchanged 78 156 0 Form and Instruction Form M-17B
Interpreter Questionnaire (Form M-11P) Unchanged 230 115 0 Form and Instruction Form M-11P
Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping Unchanged 384 384 0 Form and Instruction Form M-17E
Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent Unchanged 78 78 0 Form and Instruction Form M-17E
Interview Guide: Program Director (Form M-17D) - Recordkeeping Unchanged 384 384 0 Form and Instruction Form M-17D
Interview Guide: Program Director (Form M-17D) - Respondent Unchanged 78 78 0 Form and Instruction Form M-17D
Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping Unchanged 384 384 0 Form and Instruction Form M-17C
Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent Unchanged 312 312 0 Form and Instruction Form M-17C
Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping Unchanged 384 384 0 Form and Instruction Form M-17F
Interview Guide: Specialized Staff (Form M-17F) - Respondent Unchanged 156 156 0 Form and Instruction Form M-17F
Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping Unchanged 384 192 0 Form and Instruction Form M-17G
Interview Guide: Unaccompanied Child (Form M-17G) - Respondent Unchanged 780 390 0 Form and Instruction Form M-17G
Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping Unchanged 28 28 0 Form and Instruction Form M-13C
Legal Service Provider Questionnaire (Form M-13C) - Respondents Unchanged 114 114 0 Form and Instruction Form M-13C
Monitoring Schedule (Form M-15) Unchanged 1 0 0 Form and Instruction Form M-15
Monitoring Visit (Form M-14) - Recordkeeping Unchanged 32 16 0 Form and Instruction Form M-14
Out-of-Network Site Visit Report (Form M-3B) Unchanged 120 120 0 Form and Instruction Form M-3B
PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping Unchanged 384 768 0 Form and Instruction Form M-17H
PSA Audit Corrective Action Report (Form M-17H) - Respondent Unchanged 78 78 0 Form and Instruction Form M-17H
Personnel File Checklist (Form M-10A) - Recordkeeping Unchanged 124 124 0 Form and Instruction Form M-10A
Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping Unchanged 384 1152 0 Form and Instruction Form M-17A
Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent Unchanged 78 312 0 Form and Instruction Form M-17A
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping Unchanged 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 Unchanged 917 917 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 Unchanged 2 1 0 Form and Instruction Form M-12D
Secure Client Questionnaire (Form M-12D) - Respondents Unchanged 5 3 0 Form and Instruction Form M-12D
Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping Unchanged 0 0 0 Form and Instruction Form M-11L
Secure Detention Officer Questionnaire (Form M-11L) - Respondents Unchanged 1 1 0 Form and Instruction Form M-11L
Site Visit Guides (Forms M-7A) - Recordkeeping Unchanged 28 812 0 Form and Instruction Form M-7A
Form and Instruction Form M-7A Supplement
Site Visit Guides (Forms M-7A) - Respondents Unchanged 114 1482 0 Form and Instruction Form M-7A
Form and Instruction M-7A Supplement
Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping Unchanged 216 216 0 Form and Instruction Form M-10B
Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping Unchanged 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
Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents Unchanged 563 282 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
Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping Unchanged 216 216 0 Form and Instruction Form M-13E-UF
Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent Unchanged 224 224 0 Form and Instruction Form M-13E-UF
Unlicensed Facility Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping Unchanged 4 48 0 Form and Instruction Form M-6C-UF
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping Unchanged 18 108 0 Form and Instruction Form M-8B-UF
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents Unchanged 20 20 0 Form and Instruction Form M-8B-UF
Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping Unchanged 7 29 0 Form and Instruction M-9B-UF
Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping Unchanged 216 108 0 Form and Instruction Form M-11P-UF
Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents Unchanged 224 112 0 Form and Instruction Form M-11P-UF
Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping Unchanged 216 162 0 Form and Instruction Form M-13C-UF
Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent Unchanged 224 224 0 Form and Instruction Form M-13C-UF
Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping Unchanged 216 2592 0 Form and Instruction Form M-6A-UF
Unlicensed Facility OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping Unchanged 216 864 0 Form and Instruction Form M-9A-UF
Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping Unchanged 900 900 0 Form and Instruction Form M-10A-UF
Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping Unchanged 1800 1800 0 Form and Instruction Form M-11A-UF
Form and Instruction Form M-11C-UF
Form and Instruction Form M-11E-UF
Form and Instruction Form M-11G-UF
Form and Instruction Form M-11I-UF
Form and Instruction Form M-11J-UF
Form and Instruction Form M-11K-UF
Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents Unchanged 1792 1792 0 Form and Instruction Form M-11A-UF
Form and Instruction Form M-11C-UF
Form and Instruction Form M-11E-UF
Form and Instruction Form M-11G-UF
Form and Instruction Form M-11I-UF
Form and Instruction Form M-11J-UF
Form and Instruction Form M-11K-UF
Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping Unchanged 216 6264 0 Form and Instruction Form M-7A-UF
Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents Unchanged 224 224 0 Form and Instruction Form M-7A-UF
Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping Unchanged 36 216 0 Form and Instruction Form M-8D-UF
Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents Unchanged 40 40 0 Form and Instruction Form M-8D-UF
Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping Unchanged 1116 6696 0 Form and Instruction Form M-8A-UF
Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents Unchanged 1120 1120 0 Form and Instruction Form M-8A-UF
Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping Unchanged 1116 558 0 Form and Instruction Form M-12A-UF
Form and Instruction Form M-12As-UF
Form and Instruction Form M-12B-UF
Form and Instruction Form M-12Bs-UF
Form and Instruction Form M-12E-UF
Form and Instruction Form M-12Es-UF
Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents Unchanged 1120 560 0 Form and Instruction Form M-12A-UF
Form and Instruction Form M-12As-UF
Form and Instruction Form M-12B-UF
Form and Instruction Form M-12Bs-UF
Form and Instruction Form M-12E-UF
Form and Instruction Form M-12Es-UF
Total burden requested under this ICR: 26109 43311 0  
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