Request for Specific Consent to Juvenile Court Jurisdiction

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Request for Specific Consent to Junenile Court Jurisdiction	Form and Instruction	Modified	Available
PRA Supporting Statement for ORR-0132.12418.doc	Supporting Statement A	Uploaded 2018-03-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195192	Request for Specific Consent to Junenile Court Jurisdiction	Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0385	ICR Reference No: 201803-0970-001
Status: Active	Previous ICR Reference No: 201403-0970-005
Agency/Subagency: HHS/ACF	Agency Tracking No: ACF\ORR
Title: Request for Specific Consent to Juvenile Court Jurisdiction
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/18/2018
	Date Received in OIRA: 03/14/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2021	36 Months From Approved
Responses	30	0	0
Time Burden (Hours)	10	0	0
Cost Burden (Dollars)	221	0	0

---

Abstract: The collection of this information is needed so that ACF/ORR can recieve offiical notification by attorneys and representatives of UAC of a plannned SIJ Status action in a state court which may result in a determinination by the state court that the UAC in ORR custody will be subject to the jurisdiction of the state juvenile court. The information collection asks for the name and contact information of the UAC's attorney or representative; the UAC's biographical information; and brief explanation of why the attorney or representative is requesting that a UAC be placed in the jurisdiction of the state juvenile court. The attorney or representative is also required to attach with the request a copy a G-28, EOIR-28 or EOIR-29, or other form of authorization to act on behalf of the unaccompanied alien child.

---

Authorizing Statute(s): US Code: 6 USC 279 Name of Law: William Wilberforce
  

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:
	82 FR 26690	06/08/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 9322	03/05/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Request for Specific Consent to Junenile Court Jurisdiction	1	Request for Specific Consent

---

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	30	0	0	0	0	30
Annual Time Burden (Hours)	10	0	0	0	0	10
Annual Cost Burden (Dollars)	221	0	0	0	0	221

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: $88

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

---

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: 03/14/2018

---