View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0970-0509
ICR Reference No:
202003-0970-007
Status:
Historical Active
Previous ICR Reference No:
201801-0970-014
Agency/Subagency:
HHS/ACF
Agency Tracking No:
ORR
Title:
Medical Complaint Form, Contact Investigation Form: Non-TB Illness, and Contact Investigation Form
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
03/19/2020
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/19/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/18/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
09/30/2020
6 Months From Approved
05/31/2021
Responses
101,040
0
101,040
Time Burden (Hours)
21,182
0
21,182
Cost Burden (Dollars)
0
0
0
Abstract:
Pursuant to Exhibit 1, part A.2 of the Flores Settlement Agreement (Jenny Lisette Flores, et al., v. Janet Reno, Attorney General of the United States, et al., Case No. CV 85-4544-RJK (C.D. Cal. 1996), the Administration for Children and Families’ Office of Refugee Resettlement (ORR), on behalf of the Department of Health and Human Services (DHHS), is directed to provide unaccompanied children in their custody with medical, mental, and dental care until reunification with a qualified sponsor. Licensed care provider facilities, on behalf of ORR, are required to ensure that all children receive a complete medical examination within 48 business hours of admission including screening for infectious diseases and immunizations recommended by the U.S. Public Health Service (PHS), the Center for Disease Control and Prevention. Additional required services include routine medical and dental care, family planning services, and emergency healthcare. ORR requires care provider facilities to maintain records on each child to ensure that health-related evaluations, diagnosed illnesses/conditions, immunizations, and treatments are documented, monitored, and included in the child’s discharge packet at the time of reunification. ORR requires the Medical Complaint and Contact Investigation (Active/Suspect TB and Non-TB Illness) information collections to implement and maintain compliance with the Flores Settlement Agreement.
Emergency Justfication:
In response to the COVID-19 outbreak, the Office of Refugee Resettlement has added fields to the Medical Complaint form. To allow for immediate use, we request emergency approval for six months and will submit a full request to continue collection beyond six months. The specific changes include the addition two fields: the COVID-19 diagnosis and public health interventions.
Authorizing Statute(s):
None
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
85 FR 15476
03/18/2020
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Contact Investigation Form: Active/Suspect TB
1
Contact Investigation Form Active and Suspect
Contact Investigation Form: Non-TB Illness
1
Contact Investigation Form
Medical Complaint Form
1
Medical Complaint Form
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
101,040
101,040
0
0
0
0
Annual Time Burden (Hours)
21,182
21,182
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$131,653
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Molly Buck 202 205-4724 mary.buck@acf.hhs.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
03/18/2020
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