Information Collection and record keeping for the timely replacement and release of UC in ORR Care

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Standard Shelter Tour Request	Form and Instruction	New	Available
Form 1 URM Withdrawal or Declination of Particiapation	Form and Instruction	New	Available
Form 1 URM Application	Form and Instruction	New	Available
Form 1 Legal Service Provider List for UC	Form and Instruction	New	Available
Form 1 Notice of Rights and Provision of Services Handout	Form and Instruction	New	Available
Form 1 Child Advocate Recommendation and Appointment Form	Form and Instruction	New	Available
Form 1 Verification of Release	Form and Instruction	New	Available
Form 1 Discharge Notification	Form and Instruction	New	Repair queued
Form 1 Release Request	Form and Instruction	New	Repair queued
Form 1 Care Provider Family Reunification Checklist	Form and Instruction	New	Available
Form 1 Notice of Transfer to ICE Chief Counsel and Change of Address	Form and Instruction	New	Available
Form 1 Travel Request Form for UC Long Term Foster Care	Form and Instruction	New	Available
Form 1 Long Term Foster Care Placement Memo	Form and Instruction	New	Available
Form 1 Transfer Request and Tracking Form	Form and Instruction	New	Available
Form 1 New Sponsor Form	Form and Instruction	New	Repair queued
Form 1 UC Case Review	Form and Instruction	New	Available
Form 1 Individual Service Plan	Form and Instruction	New	Available
Form 1 UC Assessment	Form and Instruction	New	Repair queued
Form 1 Initital Intakes Assessment	Form and Instruction	New	Available
Form 1 Notice of Placement in Secure or Staff Secure	Form and Instruction	New	Available
Form 1 Placement Authorization Form	Form and Instruction	New	Available
Form 1 Further Assessment Swift Track (FAST) Placement Tool	Form and Instruction	New	Available
Form 1 UC Portal Capacity Report	Form and Instruction	New	Available
SUPSTAT_HHS_ORR-0330.doc	Supporting Statement A	Uploaded 2016-07-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222326	Standard Shelter Tour Request	Form and Instruction	New	Standard Shelter Tour Request
222325	Withdrawl of Application or Declination of Placement Form	Form and Instruction	New	URM Withdrawal or Declination of Particiapation
222324	URM Application	Form and Instruction	New	URM Application
222323	Legal Service Provider List for UC	Form and Instruction	New	Legal Service Provider List for UC
222322	Notice of Rights and Provision of Services Handout	Form and Instruction	New	Notice of Rights and Provision of Services Handout
222321	Child Advocate Referral and Appointment Form	Form and Instruction	New	Child Advocate Recommendation and Appointment Form
222320	Verification of Release	Form and Instruction	New	Verification of Release
222319	Discharge Notification	Form and Instruction	New	Discharge Notification
222318	Release Request	Form and Instruction	New	Release Request
222317	Care Provider Family Reunification Check List	Form and Instruction	New	Care Provider Family Reunification Checklist
222316	Notice of Transfer to ICE Chief Counsel and Change of Address	Form and Instruction	New	Notice of Transfer to ICE Chief Counsel and Change of Address
222315	Travel Request Form for UC Long Term Foster Care	Form and Instruction	New	Travel Request Form for UC Long Term Foster Care
222314	Long Term Foster Care Placement Memo	Form and Instruction	New	Long Term Foster Care Placement Memo
222313	Transfere Request and Tracking Form	Form and Instruction	New	Transfer Request and Tracking Form
222312	New Sponsor Form	Form and Instruction	New	New Sponsor Form
222311	UC Case Review Form	Form and Instruction	New	UC Case Review
222310	Individual Service Plan	Form and Instruction	New	Individual Service Plan
222307	UC Assessment	Form and Instruction	New	UC Assessment
222306	Initial Intakes Form	Form and Instruction	New	Initital Intakes Assessment
222302	Notice of Placement in Secure or Staff Secure Facility	Form and Instruction	New	Notice of Placement in Secure or Staff Secure
222300	Placement Authorization Form	Form and Instruction	New	Placement Authorization Form
222299	Further Assessment Swift Track (FAST) Placement Tool	Form and Instruction	New	Further Assessment Swift Track (FAST) Placement Tool
222298	UC Portal Capacity Report	Form and Instruction	New	UC Portal Capacity Report

ICR Details

OMB Control No: 0970-0498	ICR Reference No: 201606-0970-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No: ORR
Title: Information Collection and record keeping for the timely replacement and release of UC in ORR Care
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/06/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/08/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	36 Months From Approved
Responses	518,994	0	0
Time Burden (Hours)	209,297	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The ORR Unaccompanied Children Program provides placement, care, custody and mandated services for UC until such time as they can be successfully released to a sponsor, repatriated to their home country, or obtain legal status. Through cooperative agreements and contracts, ORR funds residential care providers that provide temporary housing and other services to unaccompanied children in ORR custody. These care provider facilities are State licensed and must meet ORR requirements to ensure a high level quality of care. They provide a continuum of care for children, including placements in ORR foster care, group homes, shelter, staff secure, secure, and residential treatment centers. The care providers provide children with classroom education, health care, socialization/recreation, vocational training, mental health services, access to legal services, and case management. The purpose of this information collection is allow grantees to collect information related to the provision of these services and to expeditiously provide for the timely release of unaccompanied children. The data collection also allows ORR to track grant project performance and the success of the program. In order to monitor performance and ensure compliance with statutory and regulatory requirements and standards, ORR: 1) Collects information from its network of care providers to show evidence that care providers’ standards of care, family reunification methods, internal policies and procedures, personnel, training, and other components meet minimum standards and ensure the safety and security of children in ORR care. 2) Requires care providers to track the timely release process and delivery of services for individual children and youth to ensure compliance and allow ORR to conduct formal monitoring and performance review.

---

Authorizing Statute(s): PL: Pub.L. 107 - 296 462 Name of Law: The 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:
	80 FR 57191	09/22/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 39646	06/17/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 23

table that charts list of burden

IC Title	Form No.	Form Name
Care Provider Family Reunification Check List	1	Care Provider Family Reunification Checklist
Child Advocate Referral and Appointment Form	1	Child Advocate Recommendation and Appointment Form
Discharge Notification	1	Discharge Notification
Further Assessment Swift Track (FAST) Placement Tool	1	Further Assessment Swift Track (FAST) Placement Tool
Individual Service Plan	1	Individual Service Plan
Initial Intakes Form	1	Initital Intakes Assessment
Legal Service Provider List for UC	1	Legal Service Provider List for UC
Long Term Foster Care Placement Memo	1	Long Term Foster Care Placement Memo
New Sponsor Form	1	New Sponsor Form
Notice of Placement in Secure or Staff Secure Facility	1	Notice of Placement in Secure or Staff Secure
Notice of Rights and Provision of Services Handout	1	Notice of Rights and Provision of Services Handout
Notice of Transfer to ICE Chief Counsel and Change of Address	1	Notice of Transfer to ICE Chief Counsel and Change of Address
Placement Authorization Form	1	Placement Authorization Form
Release Request	1	Release Request
Standard Shelter Tour Request	1	Standard Shelter Tour Request
Transfere Request and Tracking Form	1	Transfer Request and Tracking Form
Travel Request Form for UC Long Term Foster Care	1	Travel Request Form for UC Long Term Foster Care
UC Assessment	1	UC Assessment
UC Case Review Form	1	UC Case Review
UC Portal Capacity Report	1	UC Portal Capacity Report
URM Application	1	URM Application
Verification of Release	1	Verification of Release
Withdrawl of Application or Declination of Placement Form	1	URM Withdrawal or Declination of Particiapation

---

ICR Summary of Burden

table that charts list 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	518,994	0	0	518,994	0	0
Annual Time Burden (Hours)	209,297	0	0	209,297	0	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: No

Burden Reduction Due to:

Short Statement: This is a new clearance.

---

Annual Cost to Federal Government: $445,050

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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

---

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: 07/08/2016

---