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:
0970-0564
ICR Reference No:
202305-0970-015
Status:
Historical Active
Previous ICR Reference No:
202211-0970-002
Agency/Subagency:
HHS/ACF
Agency Tracking No:
ORR
Title:
Monitoring and Compliance for Office of Refugee Resettlement (ORR) Care Provider Facilities
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
11/03/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/31/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2026
36 Months From Approved
11/30/2023
Responses
26,109
0
19,728
Time Burden (Hours)
43,311
0
35,506
Cost Burden (Dollars)
0
0
0
Abstract:
The proposed forms in this information collection are necessary to allow the Office of Refugee Resettlement (ORR) Unaccompanied Children (UC) Program to monitor its care provider facilities for compliance with Federal and State laws and regulations, licensing and accreditation standards, ORR policies and procedures, and child welfare standards. This information collection was originally approved under emergency approval for six months, as authorized under 44 U.S.C. 3507(subsection j), due to an unanticipated event that could have reasonably resulted in public harm if normal Paperwork Reduction Act (PRA) clearance procedures were followed. Legislation in Texas (Proclamation by the Governor of the State of Texas, May 31, 2021) and Florida (Emergency Rule 65CER21-3, December 10, 2021) resulted in a large number of ORR facilities no longer being licensed by the states. To help mitigate the issue, ORR implemented quarterly monitoring visits to Texas and Florida programs. In order to implement the quarterly monitoring, ORR submitted and received emergency approval to add alternate versions of 15 forms in this information collection and reinstate three forms. This request is to continue data collection for all forms under this OMB number, including those approved under emergency approval. Revisions are proposed to some forms as described in sections A1, A2, and A15.
Authorizing Statute(s):
PL:
Pub.L. 113 - 4 1101(c)
Name of Law: Violence Against Women Reauthorization Act of 2013
US Code:
8 USC 1232
Name of Law: Trafficking Victim Protection Reauthorization Act of 2008
US Code:
6 USC 279
Name of Law: Homeland Security Act of 2002
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:
88 FR 16986
03/21/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 34858
05/31/2023
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
88
IC Title
Form No.
Form Name
Case Coordinator Questionnaire (Form M-13E) - Recordkeeping
Form M-13E
Case Coordinator Questionnaire
Case Coordinator Questionnaire (Form M-13E) - Respondents
Form M-13E
Case Coordinator Questionnaire
Checklist for a Child-Friendly Environment (Form M-4a to M-4B)
Form M-4A, Form M-4B
Checklist for a Child-Friendly Environment - Care Provider Facility
,
Checklist for a Child-Friendly Environment - Individual Foster Home
Corrective Action Report (Form M-1) - Recordkeeping
M-1
Corrective Action Report (Form M-1)
Corrective Action Report (Form M-1) - Respondents
M-1
Corrective Action Report (Form M-1)
FFS Compliance and Safety Site Visit Report (Form M-3A) - Respondents
Form M-3A
FFS Compliance and Safety Site Visit Report
Foster Care Client Questionnaire (M-12C) - Recordkeeping
Form M-12C
FC Client Questionnaire
Foster Care Client Questionnaire (M-12C) - Respondents
Form M-12C
FC Client Questionnaire
Foster Care Foster Parent Checklist (Form M-10D) - Recordkeeping
Form M-10D
Foster Care Foster Parent Checklist
Foster Care Foster Parent Questionnaire (form M-11O) - Recordkeeping
Form M-11O
Foster Parent Questionnaire
Foster Care Foster Parent Questionnaire (form M-11O) - Respondents
Form M-11O
Foster Parent Questionnaire
Foster Care Home Finder Questionnaire (Form M-11M) - Recordkeeping
Form M-11M
Foster Care Home Finder Questionnaire
Foster Care Home Finder Questionnaire (Form M-11M) - Respondents
Form M-11M
Foster Care Home Finder Questionnaire
Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Recordkeeping
Form M-11N
Foster Care Independent Living Life Skills Staff Questionnaire
Foster Care Independent Living Life Skills Staff Questionnaire (Form M-11N) - Respondents
Form M-11N
Foster Care Independent Living Life Skills Staff Questionnaire
Foster Care Legal Service Provider Questionnaire (Form M-13D) - Recordkeeping
Form M-13D
FC Legal Service Provider Questionnaire
Foster Care Legal Service Provider Questionnaire (Form M-13D) - Respondents
Form M-13D
FC Legal Service Provider Questionnaire
Foster Care Site Visit Guide (Forms M-7C) - Recordkeeping
Form M-7C
FC Site Visit Guide
Foster Care Site Visit Guide (Forms M-7C) - Respondents
Form M-7C
FC Site Visit Guide
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Recordkeeping
Form M-13B
Home Study and Post-Release Services Caseworker Questionnaire
Home Study and Post-Release Services Caseworker Questionnaire (Form M-13B) - Respondents
Form M-13B
Home Study and Post-Release Services Caseworker Questionnaire
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Recordkeeping
Form M-13A
48 - HS PRS Program Director Questionnaire
Home Study and Post-Release Services Director Questionnaire (Form M-13A) - Respondents
Form M-13A
HS PRS Program Director Questionnaire
Home Study and Post-Release Services Personnel File Checklist (Form M-10C) - Recordkeeping
Form M-10C
Home Study and Post-Release Services Personnel File Checklist
Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Recordkeeping
Form M-7E
HS PRS Site Visit Guide
Home Study and Post-Release Services Site Visit Guide (Form M-7E) - Respondents
Form M-7E
HS PRS Site Visit Guide
Incident Reviews (Forms M-5A to M-5B)
Form M-5A, Form M-5B
Incident Review
,
Adult Incident Review
Influx Care Facility Monitoring Notes (Form M-6E-UF) - Recordkeeping
Form M-6E-UF
Influx Care Facility Monitoring Notes
Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Recordkeeping
Form M-7G
Influx Care Facility Monitoring Site Visit Guide
Influx Care Facility Monitoring Site Visit Guide (Form M-7G) - Respondents
Form M-7G
Influx Care Facility Monitoring Site Visit Guide
Influx Care Facility Personnel File Checklist (Form M-10E) - Recordkeeping
Form M-10E
Influx Care Facility Personnel File Checklist
Instructions for Site Visit and Facility Tour (Form M-17B) - Recordkieeping
Form M-17B
Instructions for Site Visit and Facility Tour
Instructions for Site Visit and Facility Tour (Form M-17B) - Respondent
Form M-17B
Instructions for Site Visit and Facility Tour
Interpreter Questionnaire (Form M-11P)
Form M-11P
Interpreter Questionnaire
Interview Guide: PSA Compliance Manager (Form M-17E) - Recordkeeping
Form M-17E
Interview Guide: PSA Compliance Manager
Interview Guide: PSA Compliance Manager (Form M-17E) - Respondent
Form M-17E
Interview Guide: PSA Compliance Manager
Interview Guide: Program Director (Form M-17D) - Recordkeeping
Form M-17D
Interview Guide: Program Director
Interview Guide: Program Director (Form M-17D) - Respondent
Form M-17D
Interview Guide: Program Director
Interview Guide: Random Sample of Staff Interview (Form M-17C) - Recordkeeping
Form M-17C
Interview Guide: Random Sample of Staff Interview
Interview Guide: Random Sample of Staff Interview (Form M-17C) - Respondent
Form M-17C
Interview Guide: Random Sample of Staff Interview
Interview Guide: Specialized Staff (Form M-17F) - Recordkeeping
Form M-17F
Interview Guide: Specialized Staff
Interview Guide: Specialized Staff (Form M-17F) - Respondent
Form M-17F
Interview Guide: Specialized Staff
Interview Guide: Unaccompanied Child (Form M-17G) - Recordkeeping
Form M-17G
Interview Guide: Unaccompanied Child
Interview Guide: Unaccompanied Child (Form M-17G) - Respondent
Form M-17G
Interview Guide: Unaccompanied Child
Legal Service Provider Questionnaire (Form M-13C) - Recordkeeping
Form M-13C
Legal Service Provider Questionnaire
Legal Service Provider Questionnaire (Form M-13C) - Respondents
Form M-13C
Legal Service Provider Questionnaire
Monitoring Schedule (Form M-15)
Form M-15
Monitoring Schedule
Monitoring Visit (Form M-14) - Recordkeeping
Form M-14
Monitoring Visit
Out-of-Network Site Visit Report (Form M-3B)
Form M-3B
Out-of-Network Site Visit Report
PSA Audit Corrective Action Report (Form M-17H) - Recordkeeping
Form M-17H
PSA Audit Corrective Action Report
PSA Audit Corrective Action Report (Form M-17H) - Respondent
Form M-17H
PSA Audit Corrective Action Report
Personnel File Checklist (Form M-10A) - Recordkeeping
Form M-10A
Personnel File Checklist
Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Recordkeeping
Form M-17A
Preaudit Questionnaire and Audit Documentation Requested Checklist
Preaudit Questionnaire and Audit Documentation Requested Checklist (Form M-17A) - Respondent
Form M-17A
Preaudit Questionnaire and Audit Documentation Requested Checklist
Program Staff Questionnaires (Form M-11A-K) - Recordkeeping
Form M-11G, Form M-11D, Form M-11A, Form M-11B, Form M-11C, Form M-11E, Form M-11F, Form M-11I, Form M-11J, Form M-11K, Form M-11H
Program Director Questionnaire
,
LTFC Program Director Questionnaire
,
Clinician Questionnaire
,
LTFC Clinician Questionnaire
,
Case Manager Questionnaire
,
LTFC Case Manager Questionnaire
,
Education Staff Questionnaire
,
LTFC Educational Staff Questionnaire
,
Medical Coordinator Questionnaire
,
Youth Care Worker Questionnaire
,
PSA Compliance Manager Questionnaire
Program Staff Questionnaires (Form M-11A-K) - Respondents
Form M-11G, Form M-11C, Form M-11A, Form M-11B, Form M-11D, Form M-11E, Form M-11F, Form M-11H, Form M-11I, Form M-11J, Form M-11K
Program Director Questionnaire
,
LTFC Program Director Questionnaire
,
Clinician Questionnaire
,
LTFC Clinician Questionnaire
,
Case Manager Questionnaire
,
LTFC Case Manager Questionnaire
,
Education Staff Questionnaire
,
LTFC Educational Staff Questionnaire
,
Medical Coordinator Questionnaire
,
Youth Care Worker Questionnaire
,
PSA Compliance Manager Questionnaire
Secure Client Questionnaire (Form M-12D) - Recordkeeping
Form M-12D
Secure Client Questionnaire
Secure Client Questionnaire (Form M-12D) - Respondents
Form M-12D
Secure Client Questionnaire
Secure Detention Officer Questionnaire (Form M-11L) - Recordkeeping
Form M-11L
Secure Detention Officer Questionnaire
Secure Detention Officer Questionnaire (Form M-11L) - Respondents
Form M-11L
Secure Detention Officer Questionnaire
Site Visit Guides (Forms M-7A) - Recordkeeping
Form M-7A, Form M-7A Supplement
Site Visit Guide
,
Supplemental Personnel and Volunteer List.xlsx
Site Visit Guides (Forms M-7A) - Respondents
Form M-7A, M-7A Supplement
Site Visit Guide
,
Supplemental Personnel and Volunteer List
Supplement to Personnel File Checklist (Form M-10B) - Recordkeeping
Form M-10B
Supplement to Personnel File Checklist
Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Recordkeeping
Form M-12E, Form M-12A, Form M-12B, Form M-12As, Form M-12Bs, Form M-12Es
UC Questionnaire - Ages 6-12 Years Old - English
,
UC Questionnaire - Ages 13 and Older - English
,
UC Questionnaire - Ages 5 and Under - English
,
UC Questionnaire - Ages 6-12 Years Old - Spanish
,
UC Questionnaire - Ages 13 and Older - Spanish
,
UC Questionnaire - Ages 5 and Under - Spanish
Unaccompanied Child Questionnaires (Forms M-12A to M-12B & M-12E) - Respondents
Form M-12A , Form M-12B, Form M-12E, Form M-12As, Form M-12Bs, Form M-12Es
UC Questionnaire - Ages 6-12 Years Old - English
,
UC Questionnaire - Ages 13 and Older - English
,
UC Questionnaire - Ages 5 and Under - English
,
UC Questionnaire - Ages 6-12 Years Old - Spanish
,
UC Questionnaire - Ages 13 and Older - Spanish
,
UC Questionnaire - Ages 5 and Under - Spanish
Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Recordkeeping
Form M-13E-UF
Unlicensed Facility Case Coordinator Questionnaire
Unlicensed Facility Case Coordinator Questionnaire (Form M-13E-UF) - Respondent
Form M-13E-UF
Unlicensed Facility Case Coordinator Questionnaire
Unlicensed Facility Foster Care Monitoring Notes (Form M-6C-UF) - Recordkeeping
Form M-6C-UF
Unlicensed Facility Foster Care Monitoring Notes
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Recordkeeping
Form M-8B-UF
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist (Form M-8B-UF) - Respondents
Form M-8B-UF
Unlicensed Facility Foster Care Unaccompanied Child Case File Checklist
Unlicensed Facility Foster Home Onsite Monitoring Checklist (M-9B-UF) - Recordkeeping
M-9B-UF
Unlicensed Facility Foster Home Onsite Monitoring Checklist
Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Recordkeeping
Form M-11P-UF
Interpreter Questionnaire
Unlicensed Facility Interpreter Questionnaire (Form M-11P-UF) - Respondents
Form M-11P-UF
Interpreter Questionnaire
Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Recordkeeping
Form M-13C-UF
Legal Service Provider Questionnaire
Unlicensed Facility Legal Service Provider Questionnaire (Form M-13C-UF) - Respondent
Form M-13C-UF
Legal Service Provider Questionnaire
Unlicensed Facility Monitoring Notes (Form M-6A-UF) - Recordkeeping
Form M-6A-UF
Unlicensed Facility Monitoring Notes
Unlicensed Facility OnSite Monitoring Checklist (Form M-9A-UF) - Recordkeeping
Form M-9A-UF
Unlicensed Facility On-Site Monitoring Checklist
Unlicensed Facility Personnel File Checklist (Form M-10A-UF) - Recordkeeping
Form M-10A-UF
Unlicensed Facility Personnel File Checklist
Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Recordkeeping
Form M-11A-UF, Form M-11C-UF, Form M-11E-UF, Form M-11G-UF, Form M-11I-UF, Form M-11J-UF, Form M-11K-UF
Program Director Questionnaire
,
Clinician Questionnaire
,
Case Manager Questionnaire
,
Education Staff Questionnaire
,
Medical Coordinator Questionnaire
,
Youth Care Worker Questionnaire
,
PSA Compliance Manager Questionnaire
Unlicensed Facility Program Staff Questionnaires (Forms M-11A-UF to M-11K-UF) - Respondents
Form M-11C-UF, Form M-11A-UF, Form M-11E-UF, Form M-11G-UF, Form M-11I-UF, Form M-11J-UF, Form M-11K-UF
Program Director Questionnaire
,
Clinician Questionnaire
,
Case Manager Questionnaire
,
Education Staff Questionnaire
,
Medical Coordinator Questionnaire
,
Youth Care Worker Questionnaire
,
PSA Compliance Manager Questionnaire
Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Recordkeeping
Form M-7A-UF
Unlicensed Facility Site Visit Guide
Unlicensed Facility Site Visit Guide (Form M-7A-UF) - Respondents
Form M-7A-UF
Unlicensed Facility Site Visit Guide
Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Recordkeeping
Form M-8D-UF
Unlicensed Facility Staff Secure Addendum to Case File Checklist
Unlicensed Facility Staff Secure Addendum to Case File Checklist (Form M-8D-UF) - Respondents
Form M-8D-UF
Unlicensed Facility Staff Secure Addendum to Case File Checklist
Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Recordkeeping
Form M-8A-UF
Unlicensed Facility Unaccompanied Child Case File Checklist
Unlicensed Facility Unaccompanied Child Case File Checklist (Form M-8A-UF) - Respondents
Form M-8A-UF
Unlicensed Facility Unaccompanied Child Case File Checklist
Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Recordkeeping
Form M-12As-UF, Form M-12Bs-UF, Form M-12A-UF, Form M-12B-UF, Form M-12E-UF, Form M-12Es-UF
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish
Unlicensed Facility Unaccompanied Child Questionnaires (M-12A-UF to M-12B-UF & M-12E-UF) - Respondents
Form M-12A-UF, Form M-12As-UF, Form M-12B-UF, Form M-12Bs-UF, Form M-12E-UF, Form M-12Es-UF
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old English
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 6-12 Years Old Spanish
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older English
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 13 and Older Spanish
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under - English
,
Unlicensed Facility Unaccompanied Child Questionnaire - Ages 5 and Under Spanish
Voluntary Agency Site Visit Guide (Form M-7F) - Recordkeeping
Form M-7F
Voluntary Agency Site Visit Guide
Voluntary Agency Site Visit Guide (Form M-7F) - Respondents
Form M-7F
Voluntary Agency Site Visit Guide
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
26,109
19,728
0
4,833
1,548
0
Annual Time Burden (Hours)
43,311
35,506
0
6,494
1,311
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
This request is to extend approval of previously approved forms and to incorporate changes under this OMB number. The revisions to forms are described below, including currently requested revisions and revisions already incorporated through the most recent emergency approval. ORR has also updated burden estimates to reflect current estimates for numbers of respondents and estimated response times. See Section A15 for details about all changes proposed. NOTE: Differences in annual burden totals between the supporting statement and ROCIS are due to rounding differences in ROCIS v. Excel.
Annual Cost to Federal Government:
$1,371,918
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.
Yes
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?
No
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:
05/31/2023
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